Doctor Name: | MR. DEWONE EVERETT BENNETT |
NPI Number: | 1154653731 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S, LPC |
License Number: | |
Business Practice Address: | 11221 Nw 96th St Yukon, OK - 730999662 |
Business Phone Number: | 7073422963 |
Business Fax Number: | 4053101791 |
Mailing Address: | 11221 Nw 96th St, YUKON |
State: | OK |
Postal Code: | 730999662 |
Phone Number: | 7073422963 |
Fax Number: | 4053101791 |
NPI Enumeration Date: | 02/05/2010 |
NPI Last Update Date: | 04/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |