Provider Demographics
NPI:1902180318
Name:CYPHERS, BENITA (MS, LAC)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:CYPHERS
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 RINGGOLD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAUSHATTA
Mailing Address - State:LA
Mailing Address - Zip Code:71019-1016
Mailing Address - Country:US
Mailing Address - Phone:318-932-4029
Mailing Address - Fax:318-932-5914
Practice Address - Street 1:1313 RINGGOLD AVENUE
Practice Address - Street 2:
Practice Address - City:CAUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-1016
Practice Address - Country:US
Practice Address - Phone:318-932-4029
Practice Address - Fax:318-932-5914
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710687Medicaid
LA5C110Medicare PIN