Healthcare Provider Details

I. General information

NPI: 1801269741
Provider Name (Legal Business Name): VICTORIA LYNN BENTLEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2015
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 UNION ST STE 106
NATICK MA
01760-7700
US

IV. Provider business mailing address

17064 PENROD DR
CLINTON TOWNSHIP MI
48035-1235
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 865-748-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC12970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: