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General NPI Number Information
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NPI Number | 1265941595
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Entity Type | Organization
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Legal Business Name | BENJAMIN WHITE PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 601 S LONGMONT AVE
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City | LAFAYETTE
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State | CO
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Zip | 80026-1539
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Country | US
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Telephone | 970-281-7727
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S LONGMONT AVE
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City | LAFAYETTE
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State | CO
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Zip | 80026-1539
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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 | OWNER/MEMBER
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Name | BENJAMIN WHITE
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Credential | LCSW
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Telephone | 970-281-7727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW.09924471
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License Number State | CO
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