Provider Demographics
NPI:1831642792
Name:BENAVIDES, AMON (LMFT)
Entity Type:Individual
Prefix:
First Name:AMON
Middle Name:
Last Name:BENAVIDES
Suffix:
Gender:M
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:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91353-0093
Mailing Address - Country:US
Mailing Address - Phone:818-633-5748
Mailing Address - Fax:
Practice Address - Street 1:25050 AVENUE KEARNY STE 105
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1256
Practice Address - Country:US
Practice Address - Phone:818-633-5748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92048106H00000X
CA111800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist