MEDICARE: KYLE E BENNING LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.167222	OH
2	101YP2500X	Professional Counselor	C.2002915	OH
3	101YM0800X	Mental Health Counselor	E.2203196	OH

General Provider Information

NPI Number	:	1114418720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE E BENNING LPCC

Provider Business Mailing Address
First Line	:	8261 MARKET ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	8261 MARKET ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	12/05/2023

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Directions to “ KYLE E BENNING LPCC” Practice Location

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