Provider Demographics
NPI:1801284039
Name:BENSON, PETER (MA, LMFTA)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 W 1600 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7320
Mailing Address - Country:US
Mailing Address - Phone:208-390-4435
Mailing Address - Fax:
Practice Address - Street 1:13552 S 110 W
Practice Address - Street 2:SUITE 204
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2401
Practice Address - Country:US
Practice Address - Phone:801-999-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
UT9679668-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health