Organization
PETSBURGH THERAPY SERVICES LLC
Active
Other names
Candace D Benner
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE D BENNER MA, LPC, CCTP, EMDR (OWNER/TRAUMA SPECIALIST)
(573) 315-3848
Entity
Organization
Contact information
Practice address
19871 SACKETT LN, WAYNESVILLE, MO 65583-3510
(573) 315-3848
(573) 312-3848
Mailing address
PO BOX 114, ROBY, MO 65557-0114
(573) 315-3448
(573) 312-3848
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467869156
NPI
MO
Enumeration date
04/09/2021
Last updated
03/18/2024
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