Provider Demographics
NPI:1861742405
Name:BENSON, ELIZABETH C (MA, LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 RIVER ST N STE 109
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8266
Mailing Address - Country:US
Mailing Address - Phone:612-584-1153
Mailing Address - Fax:763-972-8808
Practice Address - Street 1:265 RIVER ST N STE 109
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8266
Practice Address - Country:US
Practice Address - Phone:612-584-1153
Practice Address - Fax:763-972-8808
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1861742405Medicaid
MN1144563883Medicaid