Individual
BLAKE BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4004 PEACH CREEK DR, WHARTON, TX 77488
(832) 621-7581
Mailing address
4004 PEACH CREEK DR, WHARTON, TX 77488-9716
(832) 621-7581
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
75171
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75171
STATE LICENSE
TX
Enumeration date
05/18/2018
Last updated
05/22/2018
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