Provider Demographics
NPI:1063183341
Name:SPEAR, BENJAMIN (PHD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SPEAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CRESCENT POINTE PKWY APT 7306
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4493
Mailing Address - Country:US
Mailing Address - Phone:608-335-2035
Mailing Address - Fax:
Practice Address - Street 1:2201 CRESCENT POINTE PKWY APT 7306
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4493
Practice Address - Country:US
Practice Address - Phone:608-335-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38371103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling