Provider Demographics
NPI:1285350082
Name:PERKINS, BEN
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 DOVERWOOD DR UNIT 26
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7256
Mailing Address - Country:US
Mailing Address - Phone:310-803-6143
Mailing Address - Fax:
Practice Address - Street 1:31450 BROAD BEACH RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2669
Practice Address - Country:US
Practice Address - Phone:877-563-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty