Provider Demographics
NPI:1891125407
Name:BENSON, DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
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 1268
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1268
Mailing Address - Country:US
Mailing Address - Phone:720-291-8915
Mailing Address - Fax:719-635-9631
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:SUITE 326
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3130
Practice Address - Country:US
Practice Address - Phone:719-583-0641
Practice Address - Fax:719-635-8631
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical