Individual
BENJAMIN A WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
307 E MAIN STREET, ASHLAND, MO 65010
(573) 250-2210
Mailing address
307 E MAIN STREET, ASHLAND, MO 65010
(573) 250-2210
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2015026369
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490025698
—
MO
Enumeration date
12/02/2013
Last updated
12/21/2023
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