Provider Demographics
NPI:1265463616
Name:BENNER, FREDERICK SAMUEL (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:SAMUEL
Last Name:BENNER
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 HAPPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-8230
Mailing Address - Country:US
Mailing Address - Phone:717-242-1428
Mailing Address - Fax:717-248-1937
Practice Address - Street 1:27 N BROWN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1734
Practice Address - Country:US
Practice Address - Phone:717-242-1428
Practice Address - Fax:717-248-1937
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional