Provider Demographics
NPI:1235798489
Name:STRAUBER, BENJAMIN A (MFTC, RP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:STRAUBER
Suffix:
Gender:M
Credentials:MFTC, RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 E 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4434
Mailing Address - Country:US
Mailing Address - Phone:303-506-6627
Mailing Address - Fax:
Practice Address - Street 1:9300 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-3406
Practice Address - Country:US
Practice Address - Phone:303-506-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2021-11-04
Deactivation Date:2020-09-17
Deactivation Code:
Reactivation Date:2021-01-24
Provider Licenses
StateLicense IDTaxonomies
CONLC.0109683103T00000X
COMFTC.0013904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist