Doctor Name: | BEN MOLTMAN |
NPI Number: | 1093962151 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MFT-I |
License Number: | APPLICANT |
Business Practice Address: | 248 Redwood Rd San Anselmo, CA - 949602736 |
Business Phone Number: | 4153705129 |
Business Fax Number: | |
Mailing Address: | 248 Redwood Rd, SAN ANSELMO |
State: | CA |
Postal Code: | 949602736 |
Phone Number: | 4153705129 |
Fax Number: | |
NPI Enumeration Date: | 08/20/2008 |
NPI Last Update Date: | 08/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | APPLICANT |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |