Individual
MRS. TISHA LYNN BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
801 HAZEN STREET, SUITE C, PAW PAW, MI 49079-0249
(269) 657-5574
(269) 657-3474
Mailing address
PO BOX 249, 801 HAZEN STREET SUITE C, PAW PAW, MI 49079-0249
(269) 657-5574
(269) 657-3474
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301009743
MI
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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