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General NPI Number Information
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NPI Number | 1043730385
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Entity Type | Organization
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Legal Business Name | BENTHAMBENTERPRISES, LTD
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 06/27/2017
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Provider Practice Location Address
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Address Line | 4710 ESPLANADE CT
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City | GRANBURY
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State | TX
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Zip | 76049-4010
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Country | US
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Telephone | 817-219-4599
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Fax | 817-219-4599
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Provider Business Mailing Address
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Address Line | 4710 ESPLANADE CT
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City | GRANBURY
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State | TX
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Zip | 76049-4010
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Country | US
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Telephone | 817-219-4599
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Fax | 817-964-3380
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK E BENTHAM
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Credential | PH.D.
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Telephone | 817-219-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 36233
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License Number State | TX
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