Provider Demographics
NPI:1962212357
Name:LEVERENTZ, BENJAMIN PHILIP (MA LPCC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:PHILIP
Last Name:LEVERENTZ
Suffix:
Gender:M
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5567 PAINTED ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9602
Mailing Address - Country:US
Mailing Address - Phone:803-260-8432
Mailing Address - Fax:
Practice Address - Street 1:700 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8370
Practice Address - Country:US
Practice Address - Phone:803-260-8432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health