Provider Demographics
NPI:1871650549
Name:BENAVIDEZ, DIANNE (LPC)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:QUINTANA-BENAVIDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:924 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3747
Mailing Address - Country:US
Mailing Address - Phone:719-564-9039
Mailing Address - Fax:719-561-8752
Practice Address - Street 1:924 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3747
Practice Address - Country:US
Practice Address - Phone:719-564-9039
Practice Address - Fax:719-561-8752
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional