Provider Demographics
NPI:1881868388
Name:LENSGRAV-BENSON, TERA LEANN (PHD)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:LEANN
Last Name:LENSGRAV-BENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84323-0706
Mailing Address - Country:US
Mailing Address - Phone:435-755-0434
Mailing Address - Fax:
Practice Address - Street 1:7852 W 600 N
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:UT
Practice Address - Zip Code:84325-9706
Practice Address - Country:US
Practice Address - Phone:435-753-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6317743-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist