Doctor Name: | JULIE LOREE BAXTER BENNETT |
NPI Number: | 1013336049 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.; LPC |
License Number: | 2012007307 |
Business Practice Address: | 380 E. Hwy Cc A105 Nixa, MO - 65714 |
Business Phone Number: | 4177258810 |
Business Fax Number: | 4177256202 |
Mailing Address: | 380 E. Hwy Cc, A105 NIXA |
State: | MO |
Postal Code: | 65714 |
Phone Number: | 4177258810 |
Fax Number: | 4177256202 |
NPI Enumeration Date: | 04/07/2014 |
NPI Last Update Date: | 05/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2012007307 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |