Benton Street Counseling LLC

NPI #1578053955 in Rolla, Missouri

Provider Information

NPI Number: 1578053955
Entity Type: Organization
Organization Name: Benton Street Counseling LLC
Primary Specialty: Counselor - Professional
Enumeration Date: May 11, 2018
Last Updated: May 11, 2018

Practice Location

Address: 1030 KINGSHIGHWAY ST STE A
City: Rolla
State: Missouri
ZIP Code: 65401-2930
Phone: (573) 458-9920

Authorized Official

Name: MARY ANN WYATT, LPC
Title: MEMBER
Phone: (573) 433-2833

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X
Counselor - Mental Health — Mental Health	101YM0800X
Counselor - Professional — Professional	101YP2500X	Primary

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