Benjamin Holloway, LCAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Hiawatha, KS
NPI 1033075650 · NPPES record last updated Dec 27, 2025
Key facts
- NPI
- 1033075650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 00914 (KS)
- Practice address
- 800 N 6TH St
Hiawatha, KS 66434-1717 - Phone
- (785) 992-1531
- NPI assigned
- Dec 27, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2705 Bishop St
Lawrence, KS 66046-5606
800 N 6TH St
Hiawatha, KS 66434-1717
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260617002644 | KS | Practitioner - Mental Health Counselor | 3274015375 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00914 | KS | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Self Connect Wellness, LLC | Addiction (Substance Use Disorder) | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 00914 | KS | Yes |
Addresses
Primary practice location
800 N 6TH St
Hiawatha, KS 66434-1717
Mailing address
PO Box 91
Hiawatha, KS 66434-0091
Other providers in Hiawatha, KS
- Gayla K Hinton
- Emily Nicole Hoffman
- Zane Hoffman
- Lauren Holland
- Hollie Williams Pmhnp LLC
- Homestead of Hiawatha Operations LLC
- Horizon Therapy Associates LLC
- Amber Howard
- Kindra Howard
- Katharine Elaine Hrencher
All providers in Hiawatha, KS · Addiction (Substance Use Disorder) Counselor in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.