Healthcare Provider Details

I. General information

NPI: 1750550828
Provider Name (Legal Business Name): YELENA DEBENEDETTO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WOODBINE PL
LONGVIEW TX
75601-2912
US

IV. Provider business mailing address

107 WOODBINE PL
LONGVIEW TX
75601-2912
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-2471
  • Fax: 903-234-1639
Mailing address:
  • Phone: 903-758-2471
  • Fax: 903-234-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number205903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: