Provider Demographics
NPI:1902846520
Name:BENSON, JOHN VALLE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VALLE
Last Name:BENSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 NW ESTELLE #11
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:AK
Mailing Address - Zip Code:97470
Mailing Address - Country:US
Mailing Address - Phone:541-440-1000
Mailing Address - Fax:541-440-1251
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6523
Practice Address - Country:US
Practice Address - Phone:541-440-1000
Practice Address - Fax:541-440-1251
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical