Provider Demographics
NPI:1497492904
Name:BROCATO, BENNY (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:BENNY
Middle Name:
Last Name:BROCATO
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N LOOP 336 W APT 1012
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3693
Mailing Address - Country:US
Mailing Address - Phone:936-900-4687
Mailing Address - Fax:
Practice Address - Street 1:2200 N LOOP 336 W APT 1012
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3693
Practice Address - Country:US
Practice Address - Phone:936-900-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health