Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO60907446 | WA |
NPI | 1003421595 |
---|---|
Provider Name | Ross Benson |
First Address | Bellevue, WA 98005-3187 |
Second Address | Bellevue, WA 98005-3187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |