Provider Demographics
NPI:1205449519
Name:BENTON, TIANA (LMHC)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAST LENOX ST
Mailing Address - Street 2:#506
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3517
Mailing Address - Country:US
Mailing Address - Phone:774-287-3839
Mailing Address - Fax:
Practice Address - Street 1:11 EAST LENOX ST
Practice Address - Street 2:#506
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-0211
Practice Address - Country:US
Practice Address - Phone:774-287-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001014101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty