Individual
TOM BENIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC-IT
Contact information
Practice address
1499 6TH ST, GREEN BAY, WI 54304-2252
(920) 497-6161
(920) 497-6161
Mailing address
1499 6TH ST, GREEN BAY, WI 54304-2252
(920) 497-6161
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3512-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3512-226
STATE LICENSE
—
Enumeration date
06/14/2017
Last updated
06/14/2017
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