Healthcare Provider Details

I. General information

NPI: 1215804018
Provider Name (Legal Business Name): BENJAMIN CLARK AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27200 TOURNEY RD STE 175
VALENCIA CA
91355-4986
US

IV. Provider business mailing address

27200 TOURNEY RD STE 175
VALENCIA CA
91355-4986
US

V. Phone/Fax

Practice location:
  • Phone: 661-705-4670
  • Fax: 661-964-3273
Mailing address:
  • Phone: 661-705-4670
  • Fax: 661-964-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT138735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: