Healthcare Provider Details

I. General information

NPI: 1306704614
Provider Name (Legal Business Name): BEN HUMMELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 W AVENIDA DE LAS FLORES
THOUSAND OAKS CA
91360-1506
US

IV. Provider business mailing address

592 W AVENIDA DE LAS FLORES
THOUSAND OAKS CA
91360-1506
US

V. Phone/Fax

Practice location:
  • Phone: 541-201-8115
  • Fax: 541-241-8447
Mailing address:
  • Phone: 512-785-1600
  • Fax: 541-241-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BEN HUMMELL JR.
Title or Position: OWNER
Credential:
Phone: 512-785-1600