Provider Demographics
NPI:1538314281
Name:BENISH, TRICIA M (P-LPE)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:M
Last Name:BENISH
Suffix:
Gender:F
Credentials:P-LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23111 INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2570
Mailing Address - Country:US
Mailing Address - Phone:501-847-5040
Mailing Address - Fax:501-847-5060
Practice Address - Street 1:23111 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2570
Practice Address - Country:US
Practice Address - Phone:501-847-5040
Practice Address - Fax:501-847-5060
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09-02 AU-PL103T00000X
AR10-20P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist