Provider Demographics
NPI:1306059373
Name:BENTON, BEVERLY (LMSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NORTH MAIN STREET
Mailing Address - Street 2:BOX 243
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0243
Mailing Address - Country:US
Mailing Address - Phone:620-855-0241
Mailing Address - Fax:620-855-3401
Practice Address - Street 1:119 AND A HALF N. MAIN
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-0243
Practice Address - Country:US
Practice Address - Phone:620-855-0241
Practice Address - Fax:620-855-3401
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW4523104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker