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General NPI Number Information
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NPI Number | 1093215642
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Entity Type | Organization
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Legal Business Name | J BENACH PSYD LLC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 4625 E BROADWAY BLVD STE 108
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City | TUCSON
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State | AZ
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Zip | 85711-3575
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Country | US
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Telephone | 520-999-0852
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12432
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City | TUCSON
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State | AZ
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Zip | 85732-2432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | JOSEPH BENACH
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Credential | PSY.D.
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Telephone | 520-999-0852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4465
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License Number State | AZ
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