Provider Demographics
NPI:1497981997
Name:KLEIN, BENJAMIN LEE (LMFT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:KLEIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-3177
Mailing Address - Country:US
Mailing Address - Phone:765-825-4124
Mailing Address - Fax:
Practice Address - Street 1:390 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3177
Practice Address - Country:US
Practice Address - Phone:765-825-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001524A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist