Provider Demographics
NPI:1508331661
Name:BENTLEY, LILLIAN RUTH (LMFT)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:RUTH
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HUMBOLDT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 HUMBOLDT RD STE 3
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8100
Practice Address - Country:US
Practice Address - Phone:530-410-0505
Practice Address - Fax:530-487-8608
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT119162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist