Provider Demographics
NPI:1508171877
Name:BENITEZ, L'OREAL GOODEN (LCMFT)
Entity Type:Individual
Prefix:
First Name:L'OREAL
Middle Name:GOODEN
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:L'OREAL
Other - Middle Name:PATRICE
Other - Last Name:GOODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMFT
Mailing Address - Street 1:2100 N RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-2515
Mailing Address - Country:US
Mailing Address - Phone:316-371-4579
Mailing Address - Fax:844-364-3047
Practice Address - Street 1:8020 E CENTRAL AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2360
Practice Address - Country:US
Practice Address - Phone:316-371-4579
Practice Address - Fax:844-364-3047
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1162106H00000X
KS764101YA0400X
KS2762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200665800AMedicaid