Provider Demographics
NPI:1831511757
Name:BENDER, ERIC N (MS LMFT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:N
Last Name:BENDER
Suffix:
Gender:M
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 WOODDALE AVE S UNIT 305
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5160
Mailing Address - Country:US
Mailing Address - Phone:651-206-9987
Mailing Address - Fax:
Practice Address - Street 1:13603 80TH CIR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-8961
Practice Address - Country:US
Practice Address - Phone:763-416-1489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-12
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2835106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist