1184985277 NPI number — MR. MARTIN VOORHIES BENDERNAGEL LPC, LCDC

Table of content: MR. MARTIN VOORHIES BENDERNAGEL LPC, LCDC (NPI 1184985277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184985277 NPI number — MR. MARTIN VOORHIES BENDERNAGEL LPC, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENDERNAGEL
Provider First Name:
MARTIN
Provider Middle Name:
VOORHIES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184985277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10615 PERRIN BEITEL ROAD, SUITE 400
Provider Second Line Business Mailing Address:
PRIMARY PRACTICE LOCATION
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-573-1349
Provider Business Mailing Address Fax Number:
210-569-6161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5825 CALLAGHAN ROAD, SUITE 200
Provider Second Line Business Practice Location Address:
SATELITTE OR SECOND PRACTICE OFFICE
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-573-1349
Provider Business Practice Location Address Fax Number:
210-569-6161
Provider Enumeration Date:
06/05/2012

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: 101YP2500X , with the licence number:  64871 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 11067 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com