Healthcare Provider Details

I. General information

NPI: 1740052240
Provider Name (Legal Business Name): SHAWNDRA BENJAMIN CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 HIGHWAY 80 E
MONROE LA
71203-8527
US

IV. Provider business mailing address

427 BIRCHWOOD DR
MONROE LA
71203-2205
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-6966
  • Fax:
Mailing address:
  • Phone: 318-351-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number5710
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number5710
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: