Healthcare Provider Details

I. General information

NPI: 1689292013
Provider Name (Legal Business Name): EMILY BENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4339 ELIOT ST
DENVER CO
80211-1636
US

IV. Provider business mailing address

108 N READING RD # 222
EPHRATA PA
17522-1668
US

V. Phone/Fax

Practice location:
  • Phone: 215-433-4494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC015538
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: