Healthcare Provider Details

I. General information

NPI: 1548567589
Provider Name (Legal Business Name): BENJAMIN SALAZAR LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 N VERDUGO RD STE 203
GLENDALE CA
91208-2875
US

IV. Provider business mailing address

PO BOX 4024
SUNLAND CA
91041-4024
US

V. Phone/Fax

Practice location:
  • Phone: 323-793-4944
  • Fax:
Mailing address:
  • Phone: 323-793-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number061333
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81042
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: