Provider Demographics
NPI:1346415650
Name:CARRETTIN, BENJAMIN WALTER (LPC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WALTER
Last Name:CARRETTIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-6025
Mailing Address - Country:US
Mailing Address - Phone:832-498-7071
Mailing Address - Fax:
Practice Address - Street 1:5909 WEST LOOP S STE 265
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2509
Practice Address - Country:US
Practice Address - Phone:832-498-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional