Provider Demographics
NPI:1891426607
Name:SPELLMAN, BENJAMIN (LMFTA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SPELLMAN
Suffix:
Gender:M
Credentials:LMFTA
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 7201
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35906-7201
Mailing Address - Country:US
Mailing Address - Phone:256-485-2190
Mailing Address - Fax:
Practice Address - Street 1:3071 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-0857
Practice Address - Country:US
Practice Address - Phone:256-485-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist