MEDICARE: SUSANNAH BENTON 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	83353	TX
2	101YP2500X	Professional Counselor	LC7179	MD

General Provider Information

NPI Number	:	1760926158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH BENTON LPC

Provider Business Mailing Address
First Line	:	8801 LA CRESADA DR APT 1013
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4520
Country	:	US
Telephone Number	:	917-757-1079
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 LA CRESADA DR APT 1013
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4520
Country	:	US
Telephone Number	:	512-222-4082
Fax Number	:

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

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	07/26/2023

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Directions to “ SUSANNAH BENTON LPC” Practice Location

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