Provider Demographics
NPI:1023790441
Name:BENEVIDES, LISA LORRAINE (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LORRAINE
Last Name:BENEVIDES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:BENEVIDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3240 DREDGE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0548
Mailing Address - Country:US
Mailing Address - Phone:406-437-8664
Mailing Address - Fax:
Practice Address - Street 1:3240 DREDGE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0548
Practice Address - Country:US
Practice Address - Phone:406-437-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-624741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical