Healthcare Provider Details

I. General information

NPI: 1366215196
Provider Name (Legal Business Name): CAROLINE BENTLEY FAMILY THERAPIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 DWIGHT RD STE 600
ELK GROVE CA
95758-6472
US

IV. Provider business mailing address

2368 MARITIME DR STE 200
ELK GROVE CA
95758-3654
US

V. Phone/Fax

Practice location:
  • Phone: 916-896-1061
  • Fax: 916-897-9821
Mailing address:
  • Phone: 916-896-1061
  • Fax: 916-897-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE BENTLEY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 916-896-1061