Provider Demographics
NPI:1598771420
Name:BENNER, SHARON L (LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:BENNER
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 1:10615 PERRIN BEITEL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3140
Mailing Address - Country:US
Mailing Address - Phone:210-535-3277
Mailing Address - Fax:
Practice Address - Street 1:10615 PERRIN BEITEL RD STE 207
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3140
Practice Address - Country:US
Practice Address - Phone:210-535-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147840602Medicaid