Provider Demographics
NPI:1821621046
Name:BENTON, JULIE (LAMFT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 E VALLEY AUTO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4609
Mailing Address - Country:US
Mailing Address - Phone:480-637-4040
Mailing Address - Fax:
Practice Address - Street 1:4111 E VALLEY AUTO DR STE 209
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4609
Practice Address - Country:US
Practice Address - Phone:480-637-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10582106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist