Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 330 | MT |
NPI | 1073536801 |
---|---|
Provider Name | Dr. Kurt P Benson |
First Address | Sheridan, WY 82801-7001 |
Second Address | Sheridan, WY 82807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 23/05/2012 |