Provider Demographics
NPI:1164055281
Name:HENSON, BANECA (LPC)
Entity Type:Individual
Prefix:
First Name:BANECA
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180291
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76096-0291
Mailing Address - Country:US
Mailing Address - Phone:214-498-2380
Mailing Address - Fax:
Practice Address - Street 1:4171 RHAPSODY ST APT 5311
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0236
Practice Address - Country:US
Practice Address - Phone:214-498-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional