Provider Demographics
NPI:1538649595
Name:BENSEN, PETRONELLAH THOKO (LPCC)
Entity type:Individual
Prefix:MRS
First Name:PETRONELLAH
Middle Name:THOKO
Last Name:BENSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:PETRONELLAH
Other - Middle Name:THOKO
Other - Last Name:BENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7030 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1370
Mailing Address - Country:US
Mailing Address - Phone:763-438-5529
Mailing Address - Fax:763-292-5653
Practice Address - Street 1:7030 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1370
Practice Address - Country:US
Practice Address - Phone:763-438-5529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC1891101Y00000X, 101YM0800X
MN1891101YM0800X
MNCC01891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN874647200OtherMEDICARE
MN000000OtherBEHAVIORAL HEALTH
MN674492400Medicaid