Active NPI
Benlon Vondre Eaglin, M.ED, LPC
- Mental Health Counselor
- Dallas, TX
National Provider Identifier
1013280106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 63356
- Practice address
- 12700 Preston Rd
Suite 150
Dallas, TX 75230 - Phone
- (940) 453-3464
- NPI assigned
- Feb 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 63356 | TX | Primary |
Addresses
Primary practice location
12700 Preston Rd
Suite 150
Dallas, TX 75230
Mailing address
12700 Preston Rd
Suite 150
Dallas, TX 75230
Phone (940) 453-3464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63356 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446595200000",
"number": "1013280106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12700 PRESTON RD",
"address_2": "SUITE 150",
"city": "DALLAS",
"state": "TX",
"postal_code": "75230",
"telephone_number": "940-453-3464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12700 PRESTON RD",
"address_2": "SUITE 150",
"city": "DALLAS",
"state": "TX",
"postal_code": "75230",
"telephone_number": "940-453-3464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EAGLIN",
"first_name": "BENLON",
"middle_name": "VONDRE",
"credential": "M.ED, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-20",
"last_updated": "2015-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "63356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.