Basic Information
| Provider Information | |||||||||
| NPI: | 1053819102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENEVEDES | ||||||||
| FirstName: | KAHLEI | ||||||||
| MiddleName: | MASHELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 N COURT ST STE B | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932913638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596271490 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 711 N COURT ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932913638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596271490 | ||||||||
| FaxNumber: | 8443680871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 101YM0800X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.