Healthcare Provider Details

I. General information

NPI: 1720852049
Provider Name (Legal Business Name): BENDELE FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 S BROADWAY ST STE 205
ORCUTT CA
93455-4656
US

IV. Provider business mailing address

1263 GRAND MEADOW WAY
ORCUTT CA
93455-2879
US

V. Phone/Fax

Practice location:
  • Phone: 602-400-9516
  • Fax:
Mailing address:
  • Phone: 805-878-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CANDACE BENDELE
Title or Position: OWNER/CEO
Credential: PHD, LMFT, BCBA-D
Phone: 805-878-6531