Provider Demographics
NPI:1659023737
Name:BENJAMIN, AGNES SARAH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:SARAH
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 MEMORIAL DR STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-6051
Mailing Address - Country:US
Mailing Address - Phone:844-824-8775
Mailing Address - Fax:
Practice Address - Street 1:12505 MEMORIAL DR STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-6051
Practice Address - Country:US
Practice Address - Phone:844-824-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69424363LP0808X
WAAP61347211363LP0808X
TX1059964363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty