Provider Demographics
NPI:1619354123
Name:BENEDICT, FOREST (MA, SATP-C, LMFT)
Entity type:Individual
Prefix:MR
First Name:FOREST
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:MA, SATP-C, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 E FIR AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3861
Mailing Address - Country:US
Mailing Address - Phone:559-323-8484
Mailing Address - Fax:
Practice Address - Street 1:1879 E FIR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3861
Practice Address - Country:US
Practice Address - Phone:559-323-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist