Provider Demographics
NPI:1245957471
Name:BENNINGER & ASSOCIATES
Entity type:Organization
Organization Name:BENNINGER & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-233-1761
Mailing Address - Street 1:130 NORTHWOODS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7473
Mailing Address - Country:US
Mailing Address - Phone:614-233-1761
Mailing Address - Fax:
Practice Address - Street 1:130 NORTHWOODS BLVD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-7473
Practice Address - Country:US
Practice Address - Phone:614-233-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235584285OtherNPI TYPE 1
OH0536321Medicaid