Provider Demographics
NPI:1477753994
Name:BENCH, ERICA LYNN (LPC, LMHC)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYNN
Last Name:BENCH
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2243 W 21ST PL APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5285
Mailing Address - Country:US
Mailing Address - Phone:816-289-9172
Mailing Address - Fax:
Practice Address - Street 1:1740 RIDGE AVE STE 208
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5909
Practice Address - Country:US
Practice Address - Phone:816-289-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015513101YP2500X
IA114317101YM0800X
MO2011000674101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health