1063473619 NPI number — DR. BENITA HELMLINGER PHD PSYCHOLOGY

Table of content: JENNIFER BANKHEAD LMT (NPI 1407614936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063473619 NPI number — DR. BENITA HELMLINGER PHD PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELMLINGER
Provider First Name:
BENITA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELMLINGER
Provider Other First Name:
TRUDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063473619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2740 FULTON AVE
Provider Second Line Business Mailing Address:
#113
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-485-4119
Provider Business Mailing Address Fax Number:
916-944-7312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 FULTON AVE
Provider Second Line Business Practice Location Address:
#113
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-485-4119
Provider Business Practice Location Address Fax Number:
916-944-7312
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY10915 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0070722 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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