| Doctor Name: | DOUGLAS W BENTLEY |
| NPI Number: | 1306819057 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 6301007196 |
| Business Practice Address: | 112 S Depot St Ionia, MI - 488461636 |
| Business Phone Number: | 6165272619 |
| Business Fax Number: | 6165277717 |
| Mailing Address: | 112 S Depot St, IONIA |
| State: | MI |
| Postal Code: | 488461636 |
| Phone Number: | 6165272619 |
| Fax Number: | 6165277717 |
| NPI Enumeration Date: | 02/10/2006 |
| NPI Last Update Date: | 08/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301007196 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |