Basic Information
| Provider Information | |||||||||
| NPI: | 1023100336 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 391 N HAYES ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820706244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077551866 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4989 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820729548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077458997 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 172V00000X | N | Other Service Providers | Community Health Worker | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.