MEDICARE: MRS. JESSICA MARIE HERNANDEZ-BENAVIDEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	71480	TX

General Provider Information

NPI Number	:	1407220130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE HERNANDEZ-BENAVIDEZ LPC

Provider Business Mailing Address
First Line	:	2939 W WOODLAWN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-5015
Country	:	US
Telephone Number	:	210-846-6173
Fax Number	:

Provider Business Practice Location Address
First Line	:	2939 W. WOODLAWN
Second Line	:	BUIDLING 2
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228
Country	:	US
Telephone Number	:	210-503-4463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	03/11/2019

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