Provider Demographics
NPI:1194867341
Name:BENTON-STEWART, LYNECE (LPC - MHSP)
Entity Type:Individual
Prefix:
First Name:LYNECE
Middle Name:
Last Name:BENTON-STEWART
Suffix:
Gender:F
Credentials:LPC - MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 MCGAVOCK PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-3224
Mailing Address - Country:US
Mailing Address - Phone:615-598-0177
Mailing Address - Fax:615-673-4904
Practice Address - Street 1:3250 DICKERSON PIKE STE 13
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207
Practice Address - Country:US
Practice Address - Phone:615-598-0177
Practice Address - Fax:615-651-8062
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TN1806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator