Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 63335 | TX |
NPI | 1003195132 |
---|---|
Provider Name | Alzada L. Benton |
First Address | Red Oak, TX 75154-4227 |
Second Address | Dallas, TX 75247-3745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2011 |
Last Update Date | 07/08/2011 |