Individual
MR. BRADLEY JUSTIN BENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AMFT
Contact information
Practice address
10116 JIBBOOM ST, TRUCKEE, CA 96161-0101
(209) 417-2819
Mailing address
10116 JIBBOOM ST, TRUCKEE, CA 96161-0101
(209) 417-2819
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
110993
CA
Other
Enumeration date
03/29/2020
Last updated
03/29/2020
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