Provider Demographics
NPI:1386851301
Name:WARNER, BENJAMIN J (PHD, LPC, LPC-S)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:WARNER
Suffix:
Gender:M
Credentials:PHD, LPC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 KIDS CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-8528
Mailing Address - Country:US
Mailing Address - Phone:512-589-1066
Mailing Address - Fax:
Practice Address - Street 1:2111 DICKSON DRIVE
Practice Address - Street 2:SUITE 16
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4788
Practice Address - Country:US
Practice Address - Phone:512-246-2232
Practice Address - Fax:512-246-8030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional