Doctor Name: | HEATHER B BENNETT |
NPI Number: | 1255519914 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | INTERN LPC |
License Number: | |
Business Practice Address: | 600 S 2nd St Central Point, OR - 975022704 |
Business Phone Number: | 5417894000 |
Business Fax Number: | 5417894023 |
Mailing Address: | 100 E Main St, Suite C MEDFORD |
State: | OR |
Postal Code: | 975016041 |
Phone Number: | 5417895526 |
Fax Number: | 5417895203 |
NPI Enumeration Date: | 02/05/2008 |
NPI Last Update Date: | 02/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |