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NPI Profile for KENOSHA BEN in CYPRESS, TX.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Intellectual & Developmental Disabilities |
103TM1800X | 62 | Psychologist, Clinical |
| NPI # | 1730816570 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 08/02/2022 | |
| Last updated | 08/02/2022 - About 4 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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KENOSHA BEN
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KENOSHA BEN