Provider Demographics
NPI:1881051936
Name:BENAVIDEZ-DURAN, ALEXANDRA (LPC (PROV))
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:BENAVIDEZ-DURAN
Suffix:
Gender:F
Credentials:LPC (PROV)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EL PUEBLO RANCH WAY
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006-2103
Mailing Address - Country:US
Mailing Address - Phone:719-404-1101
Mailing Address - Fax:
Practice Address - Street 1:1 EL PUEBLO RANCH WAY
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-2103
Practice Address - Country:US
Practice Address - Phone:719-404-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPP1382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health