Individual
JARED VAUGHN BENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
520 S EAGLE RD, STE 2104, MERIDIAN, ID 83642-6308
(208) 706-5549
(208) 706-5777
Mailing address
PO BOX 1100, BOISE, ID 83701-1100
(208) 489-4626
(208) 489-4072
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-28699
ID
Other
Enumeration date
01/03/2009
Last updated
01/03/2009
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