Provider Demographics
NPI:1386115434
Name:JUDY, BENJAMIN MASON (MA, LMHC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MASON
Last Name:JUDY
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SW TRENTON ST # 1001
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3206
Mailing Address - Country:US
Mailing Address - Phone:253-294-9429
Mailing Address - Fax:
Practice Address - Street 1:819 N 49TH ST UNIT 229
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6569
Practice Address - Country:US
Practice Address - Phone:253-294-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61166828101YM0800X
WA60927939101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health