Provider Demographics
NPI:1043385867
Name:BENTON, SHIRLEY A (LPC LMFT LCDC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:BENTON
Suffix:
Gender:F
Credentials:LPC LMFT LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 PARCHMAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180
Mailing Address - Country:US
Mailing Address - Phone:817-595-2520
Mailing Address - Fax:817-284-8742
Practice Address - Street 1:4037 PARCHMAN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-595-2520
Practice Address - Fax:817-284-8742
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC9473101Y00000X
TXLCDC1968101YA0400X
TXLMFT270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist