Healthcare Provider Details

I. General information

NPI: 1891024519
Provider Name (Legal Business Name): MR. BENJAMIN COLE HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BISSO LN STE 100
CONCORD CA
94520-4817
US

IV. Provider business mailing address

2425 BISSO LN STE 100
CONCORD CA
94520-4817
US

V. Phone/Fax

Practice location:
  • Phone: 925-521-5646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: