Provider Demographics
NPI:1861644668
Name:JOHN M. BENDA PSYCHOTHERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:JOHN M. BENDA PSYCHOTHERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENDA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-929-0781
Mailing Address - Street 1:2911 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1111
Mailing Address - Country:US
Mailing Address - Phone:612-929-0781
Mailing Address - Fax:952-285-6780
Practice Address - Street 1:4005 W 65TH ST
Practice Address - Street 2:#216
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1720
Practice Address - Country:US
Practice Address - Phone:612-929-0781
Practice Address - Fax:952-285-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN132171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty