Mark Andrew Benson, MASTERS DEGREE
Individual provider Active NPI Counselor · Normal, IL
NPI 1114232287 · NPPES record last updated May 4, 2020
Key facts
- NPI
- 1114232287
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 180003833 (IL)
- Practice address
- 112 Boeykens PL Ste 4a
Normal, IL 61761-6161 - Phone
- (309) 212-4192
- NPI assigned
- Aug 13, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180003833 | IL | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 180003833 | IL | Yes |
Addresses
Primary practice location
112 Boeykens PL Ste 4a
Normal, IL 61761-6161
Mailing address
112 Boeykens PL Ste 4a
Normal, IL 61761-6161
Phone (309) 212-4192
Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.