Provider Demographics
NPI:1447465976
Name:BENYE, COLLINS
Entity type:Individual
Prefix:MR
First Name:COLLINS
Middle Name:
Last Name:BENYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 S SHERBOURNE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1342
Mailing Address - Country:US
Mailing Address - Phone:310-815-8846
Mailing Address - Fax:
Practice Address - Street 1:11633 HAWTHORNE BLVD
Practice Address - Street 2:210
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2321
Practice Address - Country:US
Practice Address - Phone:310-978-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-B0509271001103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)