Provider Demographics
NPI:1568813137
Name:BENJAMIN, BRIEN (MA)
Entity type:Individual
Prefix:
First Name:BRIEN
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4304
Mailing Address - Country:US
Mailing Address - Phone:808-666-1054
Mailing Address - Fax:
Practice Address - Street 1:175 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-4304
Practice Address - Country:US
Practice Address - Phone:808-666-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0010525101YM0800X
COLPCC.0023152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health