Provider Demographics
NPI:1245911486
Name:BENFORD, KEADRA LATRICE
Entity type:Individual
Prefix:
First Name:KEADRA
Middle Name:LATRICE
Last Name:BENFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13907 WINTHORPE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-1180
Mailing Address - Country:US
Mailing Address - Phone:713-476-2452
Mailing Address - Fax:
Practice Address - Street 1:13907 WINTHORPE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1180
Practice Address - Country:US
Practice Address - Phone:713-476-2452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional