Provider Demographics
NPI:1770235160
Name:BENTON, EMILY MARY (MS, LPC, LCDC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MARY
Last Name:BENTON
Suffix:
Gender:F
Credentials:MS, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 AUCTION BARN RD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-8049
Mailing Address - Country:US
Mailing Address - Phone:254-424-6554
Mailing Address - Fax:
Practice Address - Street 1:2053 AUCTION BARN RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-8049
Practice Address - Country:US
Practice Address - Phone:254-424-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14488101YA0400X
TX80439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)