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General NPI Number Information
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NPI Number | 1295407484
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Entity Type | Individual
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Provider Name | MR. BENJAMIN DAVID PREISENDORF
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Gender | Male
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 17350 MOUNT HERRMANN ST STE A
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4114
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Country | US
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Telephone | 714-444-3436
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Fax |
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Provider Business Mailing Address
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Address Line | 17350 MOUNT HERRMANN ST STE A
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4114
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 146703
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License Number State | CA
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