Provider Demographics
NPI:1366215196
Name:CAROLINE BENTLEY FAMILY THERAPIST, INC
Entity type:Organization
Organization Name:CAROLINE BENTLEY FAMILY THERAPIST, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-896-1061
Mailing Address - Street 1:3137 DWIGHT RD STE 600
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6472
Mailing Address - Country:US
Mailing Address - Phone:916-896-1061
Mailing Address - Fax:
Practice Address - Street 1:3137 DWIGHT RD STE 600
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6472
Practice Address - Country:US
Practice Address - Phone:916-896-1061
Practice Address - Fax:916-897-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder