Healthcare Provider Details

I. General information

NPI: 1487775003
Provider Name (Legal Business Name): BEN W BELL M.A., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 DELAWARE ST SUITE 502
BEAUMONT TX
77706-3067
US

IV. Provider business mailing address

3560 DELAWARE ST SUITE 502
BEAUMONT TX
77706-3067
US

V. Phone/Fax

Practice location:
  • Phone: 409-899-4472
  • Fax: 409-899-9795
Mailing address:
  • Phone: 409-899-4472
  • Fax: 409-899-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: