1700050069 NPI number — LENA BENTON LPC, RN

Table of content: LENA BENTON LPC, RN (NPI 1700050069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700050069 NPI number — LENA BENTON LPC, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENTON
Provider First Name:
LENA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENTON
Provider Other First Name:
LENA
Provider Other Middle Name:
BROOKS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700050069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1481
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYLIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75098-1481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-883-1226
Provider Business Mailing Address Fax Number:
972-429-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 E PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75074-5465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-883-1226
Provider Business Practice Location Address Fax Number:
972-429-1901
Provider Enumeration Date:
04/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  10294 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 026228902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184227001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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