Provider Demographics
NPI:1760717227
Name:BENSON, J. KIMBROUGH (LPC, LMFT, NCSC)
Entity Type:Individual
Prefix:MR
First Name:J. KIMBROUGH
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:LPC, LMFT, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 JAMESTOWN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3235
Mailing Address - Country:US
Mailing Address - Phone:225-925-0035
Mailing Address - Fax:
Practice Address - Street 1:4637 JAMESTOWN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3235
Practice Address - Country:US
Practice Address - Phone:225-925-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2291101YP2500X
LA71721101YS0200X
LA767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool