Provider Demographics
NPI:1639301708
Name:BENHAM, RONALD E (DMFT)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:BENHAM
Suffix:
Gender:M
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6359
Mailing Address - Country:US
Mailing Address - Phone:303-352-1975
Mailing Address - Fax:303-352-1975
Practice Address - Street 1:8120 SHERIDAN BLVD STE 108C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6144
Practice Address - Country:US
Practice Address - Phone:303-352-1975
Practice Address - Fax:303-352-1975
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1141106H00000X
CO1139106H00000X
CO5441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist