Provider Demographics
NPI:1356700629
Name:MUNSON, BENITA (MS, LPC)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:MUNSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:BENITA
Other - Middle Name:KATRIN
Other - Last Name:BELLRICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:7810 SW GEARHART DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5979
Mailing Address - Country:US
Mailing Address - Phone:503-360-6656
Mailing Address - Fax:
Practice Address - Street 1:5319 SW WESTGATE DR STE 241
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2432
Practice Address - Country:US
Practice Address - Phone:503-360-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-12-21101YA0400X
ORC4534101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)