Basic Information
| Provider Information | |||||||||
| NPI: | 1871039818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BENHAVEN COUNSELING 2, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8227 BRECKSVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441411370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405260468 | ||||||||
| FaxNumber: | 4405260454 | ||||||||
| Practice Location | |||||||||
| Address1: | 8227 BRECKSVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441411370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405260468 | ||||||||
| FaxNumber: | 4405260454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2017 | ||||||||
| LastUpdateDate: | 01/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | HUPP | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4405260468 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MSSA, LISW-S | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 164W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0802X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.