Provider Demographics
NPI:1740823947
Name:BENIT, LYNELLE (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:LYNELLE
Middle Name:
Last Name:BENIT
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 SW 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2519
Mailing Address - Country:US
Mailing Address - Phone:503-380-3747
Mailing Address - Fax:
Practice Address - Street 1:8835 SW CANYON LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3443
Practice Address - Country:US
Practice Address - Phone:503-380-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
OR30305103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH58472OtherCENTURY SURETY COMPANY