Provider Demographics
NPI:1760926158
Name:BENTON, SUSANNAH (LPC)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:BENTON
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 1:8801 LA CRESADA DR APT 1013
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4520
Mailing Address - Country:US
Mailing Address - Phone:917-757-1079
Mailing Address - Fax:
Practice Address - Street 1:8801 LA CRESADA DR APT 1013
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4520
Practice Address - Country:US
Practice Address - Phone:512-222-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83353101YP2500X
MDLC7179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional