Provider Demographics
NPI:1982941167
Name:THERESA R BENSKY LLC
Entity Type:Organization
Organization Name:THERESA R BENSKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-344-0913
Mailing Address - Street 1:813 N LINCOLN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1300
Mailing Address - Country:US
Mailing Address - Phone:641-344-0913
Mailing Address - Fax:
Practice Address - Street 1:813 N LINCOLN ST APT 3
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1300
Practice Address - Country:US
Practice Address - Phone:641-344-0913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01222251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01199OtherBLUE CROSS / BLUE SHIELD
IA0010215Medicaid