Healthcare Provider Details

I. General information

NPI: 1487531265
Provider Name (Legal Business Name): TAHIRA LOPEZ BENEVELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W SLAUGHTER LN # 1217
AUSTIN TX
78748-6900
US

IV. Provider business mailing address

5725 TRELAWNEY LN
AUSTIN TX
78739-1763
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-4501
  • Fax:
Mailing address:
  • Phone: 713-858-5403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: