Individual
TOMAS BENITEZ III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 FIR ST STE 327, LA GRANDE, OR 97850-2663
(541) 786-3361
Mailing address
1810 G AVE APT 5, LA GRANDE, OR 97850-2848
(541) 786-3361
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T243637
OR
Other
Enumeration date
06/19/2024
Last updated
06/19/2024
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