Basic Information
| Provider Information | |||||||||
| NPI: | 1164685582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENISH | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | GARRITT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 N DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539592214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085246477 | ||||||||
| FaxNumber: | 6085248305 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 N DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539592214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085246477 | ||||||||
| FaxNumber: | 6085248305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 12/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3089125 | WI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | 297957 | WI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.