Provider Demographics
NPI:1225761505
Name:BENEMERITO, IAN (MA, LMFT, LPC)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:BENEMERITO
Suffix:
Gender:M
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 E 63RD ST STE 308D
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3385
Mailing Address - Country:US
Mailing Address - Phone:816-782-7250
Mailing Address - Fax:
Practice Address - Street 1:751 E 63RD ST STE 308D
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3385
Practice Address - Country:US
Practice Address - Phone:816-782-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022016442106H00000X
MO2024044441101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist