Provider Demographics
NPI:1710120886
Name:BENJAMIN, TERESA ANN (LMHP, PC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LMHP, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2205
Mailing Address - Country:US
Mailing Address - Phone:308-991-6919
Mailing Address - Fax:
Practice Address - Street 1:806 4TH AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2205
Practice Address - Country:US
Practice Address - Phone:308-991-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health