Basic Information
| Provider Information | |||||||||
| NPI: | 1609909241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENITES | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | LYNKA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25858 ESTABAN DR | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913552164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184045611 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 43424 COPELAND CIR STE A | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935354503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617265501 | ||||||||
| FaxNumber: | 6617265502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF40808 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | MFT47846 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.