Healthcare Provider Details

I. General information

NPI: 1154036895
Provider Name (Legal Business Name): JOEL BENAVIDES M.A., A-CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

812 S WASHINGTON ST APT B5
SALT LAKE CITY UT
84101-3051
US

V. Phone/Fax

Practice location:
  • Phone: 385-321-5356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14228058-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: