Individual
BENJAMIN DAVID PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4455 NE HW 20, CHILDREN'S FARM HOME, CORVALLIS, OR 97330
(541) 758-5900
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/23/2012
Last updated
07/19/2017
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