| Doctor Name: | BENEDICT A WALZ |
| NPI Number: | 1043376635 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS MDV MAC LADC LMFT |
| License Number: | 302151 |
| Business Practice Address: | 3333 W Division St Midtown Square Suite # 210 Saint Cloud, MN - 563014515 |
| Business Phone Number: | 3202525781 |
| Business Fax Number: | 3202525001 |
| Mailing Address: | 3333 W Division St, Midtown Square Suite # 210 SAINT CLOUD |
| State: | MN |
| Postal Code: | 563014515 |
| Phone Number: | 3202525781 |
| Fax Number: | 3202525001 |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 03/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 302151 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |