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Individual
KELLY JACOB BENINGA
Active
Individual
KELLY JACOB BENINGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, CHT
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
NLC.0110096
CO
106H00000X
Marriage & Family Therapist
Primary
NLC.0110096
CO
Other
Enumeration date
11/09/2021
Last updated
11/09/2021
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