Healthcare Provider Details

I. General information

NPI: 1194863027
Provider Name (Legal Business Name): SAMUEL BENDECK LMFT, LPCC, NCC,CPRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 GABILAN DR
SOLEDAD CA
93960
US

IV. Provider business mailing address

359 GABILAN DR
SOLEDAD CA
93960-3550
US

V. Phone/Fax

Practice location:
  • Phone: 831-678-5125
  • Fax:
Mailing address:
  • Phone: 831-678-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7653
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: