Individual
BENJI SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
75 KITTY LN, CARBONDALE, IL 62901-0013
(618) 201-3217
Mailing address
75 KITTY LN, CARBONDALE, IL 62901-0013
(618) 201-3217
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
Primary
—
IL
Other
Enumeration date
02/08/2021
Last updated
08/27/2021
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