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General NPI Number Information
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NPI Number | 1558102954
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Entity Type | Organization
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Legal Business Name | LA BENALDE INTERGRATIVE MENTAL & BEHAVIORAL HEALTH , PLLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 6044 GATEWAY BLVD E STE 444
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City | EL PASO
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State | TX
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Zip | 79905-2037
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Country | US
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Telephone | 915-203-8832
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Fax |
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Provider Business Mailing Address
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Address Line | 11232 IVANHOE DR
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City | EL PASO
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State | TX
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Zip | 79936-2207
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Country | US
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Telephone | 915-799-8416
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Fax | 915-242-0400
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN C BENEDICT
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Credential |
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Telephone | 915-203-8832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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