Provider Demographics
NPI:1487382180
Name:BENAVIDEZ, DAVID ANDREW (LMFT 203349)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:BENAVIDEZ
Suffix:
Gender:M
Credentials:LMFT 203349
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 HILLCROFT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-4224
Mailing Address - Country:US
Mailing Address - Phone:281-942-7305
Mailing Address - Fax:
Practice Address - Street 1:17043 EL CAMINO REAL STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2645
Practice Address - Country:US
Practice Address - Phone:281-942-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist