Provider Demographics
NPI:1235512617
Name:WAYBURN, BENJAMIN (LPC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:WAYBURN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16264 STONEBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3531
Mailing Address - Country:US
Mailing Address - Phone:720-470-8782
Mailing Address - Fax:
Practice Address - Street 1:2101 S BLACKHAWK ST STE 240
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1475
Practice Address - Country:US
Practice Address - Phone:720-470-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO.0016818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health