Provider Demographics
NPI:1841636008
Name:BENAS, BRENNA ELAINE (BSW, CADC)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:ELAINE
Last Name:BENAS
Suffix:
Gender:F
Credentials:BSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 MOUN TAIN VIEW
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:170-228-7548
Mailing Address - Fax:170-238-5551
Practice Address - Street 1:401 S MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4313
Practice Address - Country:US
Practice Address - Phone:170-238-5333
Practice Address - Fax:170-238-5551
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00327-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)