Healthcare Provider Details

I. General information

NPI: 1912072448
Provider Name (Legal Business Name): MS. BREENA BENEFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRIS WELZ

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18357 W BERYL CT
WADDELL AZ
85355-4355
US

IV. Provider business mailing address

18357 W BERYL CT
WADDELL AZ
85355-4355
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-9484
  • Fax:
Mailing address:
  • Phone: 623-977-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number11346
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: