Provider Demographics
NPI:1801194287
Name:BENDER, DEANNE KATHLEEN LARSON (MFT)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:KATHLEEN LARSON
Last Name:BENDER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12623 COUNTRY MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2717
Mailing Address - Country:US
Mailing Address - Phone:661-513-6347
Mailing Address - Fax:
Practice Address - Street 1:12623 COUNTRY MEADOW ST
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2717
Practice Address - Country:US
Practice Address - Phone:661-513-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist