Provider Demographics
NPI:1396366340
Name:BENEDICT MENTAL HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:BENEDICT MENTAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:HORACE
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-551-8185
Mailing Address - Street 1:3503 BOCA CHICA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-6675
Mailing Address - Country:US
Mailing Address - Phone:210-675-0066
Mailing Address - Fax:210-247-9611
Practice Address - Street 1:3503 BOCA CHICA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-6675
Practice Address - Country:US
Practice Address - Phone:210-675-0066
Practice Address - Fax:210-247-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty