Provider Demographics
NPI:1285138206
Name:CONNIE Y BENFIELD PHD PLLC
Entity type:Organization
Organization Name:CONNIE Y BENFIELD PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-426-8710
Mailing Address - Street 1:534 PROSPERITY RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-5583
Mailing Address - Country:US
Mailing Address - Phone:512-426-8710
Mailing Address - Fax:325-691-6259
Practice Address - Street 1:4601 ANTILLEY RD STE 304
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5914
Practice Address - Country:US
Practice Address - Phone:325-370-8416
Practice Address - Fax:325-691-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty