Provider Demographics
NPI:1083829352
Name:BENEDICT, MARILYN DORIS FISK (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:DORIS FISK
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2693 HIGHWAY 77 NORTH
Mailing Address - Street 2:SUITE 2103
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-617-7787
Mailing Address - Fax:972-617-2268
Practice Address - Street 1:2693 HIGHWAY 77 NORTH
Practice Address - Street 2:SUITE 2103
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-617-7787
Practice Address - Fax:972-617-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX02357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026485502Medicaid