Provider Demographics
NPI:1912072448
Name:BENEFIELD, BREENA
Entity Type:Individual
Prefix:MS
First Name:BREENA
Middle Name:
Last Name:BENEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:WELZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18357 W BERYL CT
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-4355
Mailing Address - Country:US
Mailing Address - Phone:623-977-9484
Mailing Address - Fax:
Practice Address - Street 1:18357 W BERYL CT
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-4355
Practice Address - Country:US
Practice Address - Phone:623-977-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11346385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113717OtherAHCCCS ID NUMBER