Provider Demographics
NPI:1588724371
Name:JG BENEDICT, PHD & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:JG BENEDICT, PHD & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENEDICT, PHD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-466-3509
Mailing Address - Street 1:7555 E. HAMPDEN AVE
Mailing Address - Street 2:#535
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4836
Mailing Address - Country:US
Mailing Address - Phone:303-358-1455
Mailing Address - Fax:720-535-1934
Practice Address - Street 1:22485 SUNSET CR.
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401
Practice Address - Country:US
Practice Address - Phone:720-466-3509
Practice Address - Fax:303-753-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO177103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
95346OtherBCBS
CO07025281Medicaid
95346OtherBCBS