Provider Demographics
NPI:1992572127
Name:BENJAMIN-BUBB, BEVERLY LEMONNE (LPC-A)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LEMONNE
Last Name:BENJAMIN-BUBB
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 GREEN OAK PL STE 250
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2044
Mailing Address - Country:US
Mailing Address - Phone:281-608-1346
Mailing Address - Fax:832-436-1648
Practice Address - Street 1:1521 GREEN OAK PL STE 250
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2044
Practice Address - Country:US
Practice Address - Phone:281-608-1346
Practice Address - Fax:832-436-1648
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health