Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003145806 |
---|---|
Provider Name | Maya K Benham |
First Address | Mcminnville, OR 97128-4408 |
Second Address | Mcminnville, OR 97128-4408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2009 |
Last Update Date | 08/12/2009 |