Provider Demographics
NPI:1952433534
Name:BENEDICT, STACY DIANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:DIANNE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PINTAIL ST
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-7693
Mailing Address - Country:US
Mailing Address - Phone:940-231-0122
Mailing Address - Fax:
Practice Address - Street 1:400 PINTAIL ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-7693
Practice Address - Country:US
Practice Address - Phone:940-231-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional