Provider Information for 1235512617
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BENJAMIN WAYBURN LPC
Sex: Male
NPI: 1235512617
Last Updated: 2021-04-12
Certification Date: 2021-04-12
Certification Date: 2021-04-12
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1235512617 | ||||||||||||
| Enumeration Date | 2015-07-03 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 16264 STONEBRIAR DR PARKER, CO 80134-3531 United States Phone: 720-470-8782 | Fax: | ||||||||||||
| Primary Practice Address | 2101 S BLACKHAWK ST STE 240 AURORA, CO 80014-1475 United States Phone: 720-470-8782 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 265 S HARLAN ST | ||||||||||||
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