Provider Demographics
NPI:1578260428
Name:PERALES, BENITO AUGUSTINE
Entity Type:Individual
Prefix:
First Name:BENITO
Middle Name:AUGUSTINE
Last Name:PERALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W RAMPART DR APT 703
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6771
Mailing Address - Country:US
Mailing Address - Phone:210-627-1516
Mailing Address - Fax:
Practice Address - Street 1:165 W RAMPART DR APT 703
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6771
Practice Address - Country:US
Practice Address - Phone:210-627-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health