Provider Demographics
NPI:1407272461
Name:BENEDICT, KIMBERLY (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:F
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:PO BOX 2304
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-6304
Mailing Address - Country:US
Mailing Address - Phone:361-816-2327
Mailing Address - Fax:361-257-1776
Practice Address - Street 1:203 SADDLE MOUNTAIN DR.
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3821
Practice Address - Country:US
Practice Address - Phone:361-816-2327
Practice Address - Fax:361-257-1776
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61852101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3361313-07Medicaid
TX336131302Medicaid