Healthcare Provider Details

I. General information

NPI: 1114871134
Provider Name (Legal Business Name): MARIGOLD MIND & MOVEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5199 E PACIFIC COAST HWY STE 308
LONG BEACH CA
90804-3358
US

IV. Provider business mailing address

5199 E PACIFIC COAST HWY STE 308
LONG BEACH CA
90804-3358
US

V. Phone/Fax

Practice location:
  • Phone: 562-551-0877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHAI B BENSON
Title or Position: OWNER
Credential:
Phone: 440-218-4090