Doctor Name: | MR. BRENT (NMN) BENGTSON |
NPI Number: | 1295718484 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LSCSW, LCSW, ACSW |
License Number: | LSCSW #550 |
Business Practice Address: | 550 Pope Ave Munson Army Health Center Attn: Mcxn-cod Ms. Cutton Fort Leavenworth, KS - 660272332 |
Business Phone Number: | 9136846562 |
Business Fax Number: | 9136846208 |
Mailing Address: | 12815 W 118th St, OVERLAND PARK |
State: | KS |
Postal Code: | 662101311 |
Phone Number: | 9133399395 |
Fax Number: | |
NPI Enumeration Date: | 11/22/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LSCSW #550 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |