Provider Demographics
NPI:1659993970
Name:ANDERSON, BENTLY JAMES WATANABE (LMFT#146945)
Entity type:Individual
Prefix:MR
First Name:BENTLY
Middle Name:JAMES WATANABE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMFT#146945
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 SACRAMENTO ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1897
Mailing Address - Country:US
Mailing Address - Phone:510-574-2100
Mailing Address - Fax:510-254-7225
Practice Address - Street 1:3530 SACRAMENTO ST STE 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1897
Practice Address - Country:US
Practice Address - Phone:510-804-0366
Practice Address - Fax:510-254-7225
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA146945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health