Provider Demographics
NPI:1184270282
Name:MOLIN, BENJAMIN ALLEN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALLEN
Last Name:MOLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 W 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3758
Mailing Address - Country:US
Mailing Address - Phone:541-686-2688
Mailing Address - Fax:
Practice Address - Street 1:2655 MLK BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5899
Practice Address - Country:US
Practice Address - Phone:541-790-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool