Provider Demographics
NPI:1376209650
Name:BENAMON, AUSTIN GEORGE
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:GEORGE
Last Name:BENAMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12848 QUEENSBURY LN STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4163
Mailing Address - Country:US
Mailing Address - Phone:866-806-5347
Mailing Address - Fax:216-710-6801
Practice Address - Street 1:12848 QUEENSBURY LN STE 208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4163
Practice Address - Country:US
Practice Address - Phone:866-806-5347
Practice Address - Fax:216-710-6801
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health