Provider Demographics
NPI:1174993984
Name:SALICCO, BENJAMIN CHRISTOPHER (MA, LPC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CHRISTOPHER
Last Name:SALICCO
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9109 SEMINOLE CIR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-7038
Mailing Address - Country:US
Mailing Address - Phone:480-309-9660
Mailing Address - Fax:
Practice Address - Street 1:9109 SEMINOLE CIR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-7038
Practice Address - Country:US
Practice Address - Phone:480-309-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional