Provider Demographics
NPI:1326877929
Name:BENEBY, PHILYSHA CAROL
Entity type:Individual
Prefix:
First Name:PHILYSHA
Middle Name:CAROL
Last Name:BENEBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 NICOLLETT WAY
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-2946
Mailing Address - Country:US
Mailing Address - Phone:813-576-9403
Mailing Address - Fax:
Practice Address - Street 1:2204 NICOLLETT WAY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-2946
Practice Address - Country:US
Practice Address - Phone:813-576-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty