Provider Demographics
NPI:1235456625
Name:GLEAVES, BENJAMIN LOUIS (MAMFT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LOUIS
Last Name:GLEAVES
Suffix:
Gender:M
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 STERLING POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5256
Mailing Address - Country:US
Mailing Address - Phone:405-464-3268
Mailing Address - Fax:
Practice Address - Street 1:601 N.E. 63RD STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105
Practice Address - Country:US
Practice Address - Phone:405-840-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health