Provider Demographics
NPI:1760912083
Name:BENEFIELD, LARA NATASHA (LMFT)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:NATASHA
Last Name:BENEFIELD
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 1:51 ESSEX ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2445
Mailing Address - Country:US
Mailing Address - Phone:415-299-9942
Mailing Address - Fax:
Practice Address - Street 1:2915 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2133
Practice Address - Country:US
Practice Address - Phone:415-299-9942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist