Provider Demographics
NPI:1376379313
Name:BENEDICT, MICHELE M (MFT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 VIA DEL CAMPO
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-0939
Mailing Address - Country:US
Mailing Address - Phone:818-701-0108
Mailing Address - Fax:
Practice Address - Street 1:935 VIA DEL CAMPO
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-0939
Practice Address - Country:US
Practice Address - Phone:818-701-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31685106H00000X
NV01368106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist