Provider Demographics
NPI:1982852323
Name:BENOIT, WILFRED DOUGLAS (MFT)
Entity Type:Individual
Prefix:MR
First Name:WILFRED
Middle Name:DOUGLAS
Last Name:BENOIT
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:DOUGLAS
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:1005 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-8528
Mailing Address - Country:US
Mailing Address - Phone:831-234-8672
Mailing Address - Fax:
Practice Address - Street 1:12880 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9114
Practice Address - Country:US
Practice Address - Phone:831-234-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist