MEDICARE: MR. STEPHEN BENINTENDI LPC, SRT, EMDR

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	101YP2500X	Professional Counselor	2015026802	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2015026802	OTHER	MO	STATE OF MISSOURI PLPC

General Provider Information

NPI Number	:	1659748754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN BENINTENDI LPC, SRT, EMDR

Provider Business Mailing Address
First Line	:	4140 E CRIGHTON PL
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-2363
Country	:	US
Telephone Number	:	417-234-9718
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 E SAINT LOUIS ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-3129
Country	:	US
Telephone Number	:	417-833-9999
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	05/01/2018

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