Phillip Michael Benavides

Primary specialty

CounselorTaxonomy code 101Y00000X

License

77347 Issued in TX

Practice address

2225 Parker Rd
Carrollton, TX 75010-4711

Phone

(972) 242-4114

NPI assigned

Mar 22, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584835200000",
    "number": "1861028706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4208 STONE TRAIL DR",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762101517",
            "telephone_number": "214-621-3065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 PARKER RD",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104711",
            "telephone_number": "972-242-4114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4208 Stone Trail Dr",
            "address_purpose": "LOCATION",
            "city": "Denton",
            "state": "TX",
            "postal_code": "762101517",
            "country_code": "US",
            "telephone_number": "214-621-3065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENAVIDES",
        "first_name": "PHILLIP",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-22",
        "last_updated": "2020-03-22",
        "certification_date": "2020-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "77347",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "77347",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "77347",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "77347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.