Doctor Name: | MS. MARILYN DORIS FISK BENEDICT |
NPI Number: | 1083829352 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS LPC |
License Number: | 02357 |
Business Practice Address: | 2693 Highway 77 North Suite 2103 Waxahachie, TX - 75165 |
Business Phone Number: | 9726177787 |
Business Fax Number: | 9726172268 |
Mailing Address: | 2693 Highway 77 North, Suite 2103 WAXAHACHIE |
State: | TX |
Postal Code: | 75165 |
Phone Number: | 9726177787 |
Fax Number: | 9726172268 |
NPI Enumeration Date: | 05/11/2007 |
NPI Last Update Date: | 05/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 02357 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |