| Doctor Name: | AMANDA BENSON |
| NPI Number: | 1467838151 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., LCPC |
| License Number: | 2009032848 |
| Business Practice Address: | 1161 Fortune Blvd Suite 400 Shiloh, IL - 622697385 |
| Business Phone Number: | 6188308146 |
| Business Fax Number: | 6182068476 |
| Mailing Address: | 912 Monterey Dr, O FALLON |
| State: | IL |
| Postal Code: | 622692833 |
| Phone Number: | 6188308146 |
| Fax Number: | 6182068476 |
| NPI Enumeration Date: | 08/04/2015 |
| NPI Last Update Date: | 08/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2009032848 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |