Provider Demographics
NPI:1780107391
Name:BENN, COURTNEY (LMFT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BENN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 VIA SEPULVEDA UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4447
Mailing Address - Country:US
Mailing Address - Phone:619-575-4687
Mailing Address - Fax:
Practice Address - Street 1:4449 VIA SEPULVEDA UNIT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-4447
Practice Address - Country:US
Practice Address - Phone:619-339-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF79497106H00000X
CA155219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist