Provider Demographics
NPI:1952873010
Name:BENSON, NICHOLAS FRANK (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:FRANK
Last Name:BENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ELLIS FARM RD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3777
Mailing Address - Country:US
Mailing Address - Phone:605-659-0396
Mailing Address - Fax:
Practice Address - Street 1:116 ELLIS FARM RD
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3777
Practice Address - Country:US
Practice Address - Phone:605-659-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist