Provider Demographics
NPI:1104441948
Name:HIGGINS, BENJAMIN (MA, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2708
Mailing Address - Country:US
Mailing Address - Phone:615-957-3854
Mailing Address - Fax:
Practice Address - Street 1:614 E 4TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2708
Practice Address - Country:US
Practice Address - Phone:615-957-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4094OtherLPC-MHSP