Provider Demographics
NPI:1477853497
Name:BERRYMAN, BENJAMIN DANIEL (LMFT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:BERRYMAN
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 1:2365 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-3208
Mailing Address - Country:US
Mailing Address - Phone:316-321-6036
Mailing Address - Fax:316-321-6336
Practice Address - Street 1:2365 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3208
Practice Address - Country:US
Practice Address - Phone:316-321-6036
Practice Address - Fax:316-321-6336
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist