Provider Demographics
NPI:1700050069
Name:BENTON, LENA (LPC, RN)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:BROOKS
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, RN
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1481
Mailing Address - Country:US
Mailing Address - Phone:214-883-1226
Mailing Address - Fax:972-429-1901
Practice Address - Street 1:900 E PARK BLVD
Practice Address - Street 2:SUITE 155
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5465
Practice Address - Country:US
Practice Address - Phone:214-883-1226
Practice Address - Fax:972-429-1901
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10294101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026228902Medicaid
TX184227001Medicaid