Provider Demographics
NPI:1316646060
Name:MAXSON, BENJAMIN ALLAN (AMFT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALLAN
Last Name:MAXSON
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34232 PACIFIC COAST HWY STE D
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3856
Mailing Address - Country:US
Mailing Address - Phone:949-304-3404
Mailing Address - Fax:
Practice Address - Street 1:34232 PACIFIC COAST HWY STE D
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3856
Practice Address - Country:US
Practice Address - Phone:949-304-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist