Provider Demographics
NPI:1194863027
Name:BENDECK, SAMUEL (LMFT, LPCC, NCC,CPRP)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:BENDECK
Suffix:
Gender:M
Credentials:LMFT, LPCC, NCC,CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 GABILAN DR
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-3550
Mailing Address - Country:US
Mailing Address - Phone:831-678-5125
Mailing Address - Fax:
Practice Address - Street 1:359 GABILAN DR
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960
Practice Address - Country:US
Practice Address - Phone:831-678-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115534106H00000X
CA7653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional