Provider Demographics
NPI:1376922351
Name:HUMMELL, BEN JR (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:HUMMELL
Suffix:JR
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CLEAR CREEK DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1882
Mailing Address - Country:US
Mailing Address - Phone:541-201-8115
Mailing Address - Fax:541-241-8447
Practice Address - Street 1:149 CLEAR CREEK DR UNIT 102
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1882
Practice Address - Country:US
Practice Address - Phone:541-201-8115
Practice Address - Fax:541-241-8447
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-24
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83809106H00000X
ORC3898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist