Provider Demographics
NPI:1154468759
Name:BENNER, JANICE L (MA)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:L
Last Name:BENNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 TABLE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3578
Mailing Address - Country:US
Mailing Address - Phone:530-538-3867
Mailing Address - Fax:
Practice Address - Street 1:107 PARMAC RD
Practice Address - Street 2:STE.4
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2298
Practice Address - Country:US
Practice Address - Phone:530-891-2850
Practice Address - Fax:530-895-6549
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 47728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist