Individual
MS. BREENA BENEFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18357 W BERYL CT, WADDELL, AZ 85355-4355
(623) 977-9484
Mailing address
18357 W BERYL CT, WADDELL, AZ 85355-4355
(623) 977-9484
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
11346
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113717
AHCCCS ID NUMBER
AZ
Enumeration date
11/21/2006
Last updated
10/25/2007
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