Healthcare Provider Details

I. General information

NPI: 1235798489
Provider Name (Legal Business Name): BENJAMIN A STRAUBER MFTC, RP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date: 09/17/2020
Reactivation Date: 01/24/2021

III. Provider practice location address

3101 W 14TH AVE
DENVER CO
80204-2203
US

IV. Provider business mailing address

3101 W 14TH AVE
DENVER CO
80204-2203
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-7900
  • Fax:
Mailing address:
  • Phone: 303-506-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNLC.0109683
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0013904
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: