MEDICARE: VICTORIA SUSAN BENTON LPC

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	101YM0800X	Mental Health Counselor	1640	LA

General Provider Information

NPI Number	:	1417910365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA SUSAN BENTON LPC

Provider Business Mailing Address
First Line	:	1234 DEL ESTE AVE STE 402
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4829
Country	:	US
Telephone Number	:	225-273-0106
Fax Number	:	225-463-3242

Provider Business Practice Location Address
First Line	:	1234 DEL ESTE AVE STE 402
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4829
Country	:	US
Telephone Number	:	225-273-0106
Fax Number	:	225-463-3242

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	10/29/2024

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