Provider Demographics
NPI:1447487640
Name:LLANOS, BENJAMIN (MS, LADC U/S)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LLANOS
Suffix:
Gender:M
Credentials:MS, LADC U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W. MAIN
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080
Mailing Address - Country:US
Mailing Address - Phone:405-527-1785
Mailing Address - Fax:405-527-1084
Practice Address - Street 1:1719 SW 11TH
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501
Practice Address - Country:US
Practice Address - Phone:580-581-1818
Practice Address - Fax:580-581-1819
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)