Provider Demographics
NPI:1740324938
Name:BENEDICT, EUGENE HIRAM (MA LPC)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:HIRAM
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:MR
Other - First Name:EUGENE
Other - Middle Name:HIRAM
Other - Last Name:BENEDICT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LPC
Mailing Address - Street 1:8535 WURZBACH RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1263
Mailing Address - Country:US
Mailing Address - Phone:210-697-8191
Mailing Address - Fax:210-697-8193
Practice Address - Street 1:8535 WURZBACH RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1263
Practice Address - Country:US
Practice Address - Phone:210-697-8191
Practice Address - Fax:210-697-8193
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1643884-01Medicaid