Provider Demographics
NPI:1770511172
Name:BENDER, JUSTIN (LPC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2868 ACTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-968-8360
Mailing Address - Fax:205-968-8373
Practice Address - Street 1:1015 MONTLIMAR DRIVE
Practice Address - Street 2:STE A180
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609
Practice Address - Country:US
Practice Address - Phone:251-343-4101
Practice Address - Fax:251-343-4789
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521620OtherBCBS