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General NPI Number Information
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NPI Number | 1447465976
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Entity Type | Individual
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Provider Name | MR. COLLINS BENYE
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11633 HAWTHORNE BLVD 210
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City | HAWTHORNE
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State | CA
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Zip | 90250-2321
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Country | US
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Telephone | 310-978-0461
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Fax |
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Provider Business Mailing Address
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Address Line | 1951 S SHERBOURNE DR APT 3
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City | LOS ANGELES
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State | CA
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Zip | 90034-1342
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Country | US
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Telephone | 310-815-8846
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | RI-B0509271001
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License Number State | CA
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