Healthcare Provider Details

I. General information

NPI: 1154092773
Provider Name (Legal Business Name): DR RON BENHAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 SHERIDAN BLVD STE 108C
WESTMINSTER CO
80003-6144
US

IV. Provider business mailing address

3220 OTIS ST
WHEAT RIDGE CO
80033-6359
US

V. Phone/Fax

Practice location:
  • Phone: 303-352-1975
  • Fax: 303-352-1975
Mailing address:
  • Phone: 303-352-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD EUGENE BENHAM
Title or Position: OWNER
Credential: DMFT
Phone: 303-352-1975