Provider Demographics
NPI:1174140891
Name:BENAVIDES, JEANNETTE MELISSA (LMFT 145697)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MELISSA
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:LMFT 145697
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 E LINCOLN AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1934
Mailing Address - Country:US
Mailing Address - Phone:619-500-3840
Mailing Address - Fax:
Practice Address - Street 1:1442 E LINCOLN AVE STE 117
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1934
Practice Address - Country:US
Practice Address - Phone:619-500-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT145697106H00000X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist