Provider Demographics
NPI:1427204452
Name:BENNO, ALEC M
Entity Type:Individual
Prefix:MR
First Name:ALEC
Middle Name:M
Last Name:BENNO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARC
Other - Middle Name:A
Other - Last Name:BENNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:159 MERRITT ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNT
Mailing Address - State:TX
Mailing Address - Zip Code:78024-3463
Mailing Address - Country:US
Mailing Address - Phone:830-329-7200
Mailing Address - Fax:
Practice Address - Street 1:625 CLAY ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4586
Practice Address - Country:US
Practice Address - Phone:830-329-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)