Provider Demographics
NPI:1679636609
Name:STEPHEN L. BENSON, PSYD, P.A.
Entity type:Organization
Organization Name:STEPHEN L. BENSON, PSYD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:316-263-2351
Mailing Address - Street 1:833 N WACO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3955
Mailing Address - Country:US
Mailing Address - Phone:316-263-2351
Mailing Address - Fax:316-263-3685
Practice Address - Street 1:833 N WACO AVE STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3955
Practice Address - Country:US
Practice Address - Phone:316-263-2351
Practice Address - Fax:316-263-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119885Medicare ID - Type UnspecifiedMEDICARE NUMBER