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Individual

AMANDA BENSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.A., LCPC

Contact information

Practice address
1161 FORTUNE BLVD, SUITE 400, SHILOH, IL 62269-7385
(618) 830-8146
(618) 206-8476
Mailing address
912 MONTEREY DR, O FALLON, IL 62269-2833
(618) 830-8146
(618) 206-8476

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.008106
IL
101YP2500X
Professional Counselor
2009032848
MO

Other

Enumeration date
08/04/2015
Last updated
08/04/2015
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