Provider Demographics
NPI:1013486406
Name:SMALLEY, BENJAMIN STEPHEN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:STEPHEN
Last Name:SMALLEY
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 1:3300 CLINTON PARKWAY CT STE 206
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2660
Mailing Address - Country:US
Mailing Address - Phone:913-343-1028
Mailing Address - Fax:
Practice Address - Street 1:3300 CLINTON PARKWAY CT STE 206
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2660
Practice Address - Country:US
Practice Address - Phone:913-343-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist