Provider Demographics
NPI:1164891891
Name:BENITEZ, KATHLINE (CADC)
Entity Type:Individual
Prefix:
First Name:KATHLINE
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 NE GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4607
Mailing Address - Country:US
Mailing Address - Phone:541-617-7365
Mailing Address - Fax:541-504-1195
Practice Address - Street 1:340 NW 5TH ST STE 202
Practice Address - Street 2:BOX 1710
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1869
Practice Address - Country:US
Practice Address - Phone:541-516-4087
Practice Address - Fax:541-504-1195
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-05-05101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health