Provider Demographics
NPI:1396582359
Name:BENAVIDES, JACLYN (LPC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-ASSOCIATE
Mailing Address - Street 1:13665 TEAGUE LN UNIT 202
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5244
Mailing Address - Country:US
Mailing Address - Phone:361-229-4765
Mailing Address - Fax:
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-369-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health