Healthcare Provider Details

I. General information

NPI: 1023495033
Provider Name (Legal Business Name): JUDITH BENVENUTO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY BENVENUTO LMFT

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EL CAMINO REAL STE 213
TUSTIN CA
92780-3656
US

IV. Provider business mailing address

250 EL CAMINO REAL STE 213
TUSTIN CA
92780-3656
US

V. Phone/Fax

Practice location:
  • Phone: 714-393-1891
  • Fax: 714-805-6519
Mailing address:
  • Phone: 714-393-1891
  • Fax: 714-805-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number88175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: