Provider Demographics
NPI:1659748754
Name:BENINTENDI, STEPHEN (LPC, SRT, EMDR)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BENINTENDI
Suffix:
Gender:M
Credentials:LPC, SRT, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 E CRIGHTON PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2363
Mailing Address - Country:US
Mailing Address - Phone:417-234-9718
Mailing Address - Fax:
Practice Address - Street 1:1623 E SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3129
Practice Address - Country:US
Practice Address - Phone:417-833-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015026802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015026802OtherSTATE OF MISSOURI PLPC