Provider Demographics
NPI:1346824505
Name:CONDRAY, BENJAMIN GRADY (LPC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:GRADY
Last Name:CONDRAY
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 1:1850 S MIDLOTHIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7581
Mailing Address - Country:US
Mailing Address - Phone:972-775-9050
Mailing Address - Fax:
Practice Address - Street 1:1850 S MIDLOTHIAN PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7581
Practice Address - Country:US
Practice Address - Phone:972-824-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional