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NPI Code Detail

MEDICARE: KELLY MARIE BENNETT LMHC

MEDICARE: KELLY MARIE BENNETT LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor39002205AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144356437
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MARIE BENNETT LMHC
Provider Business Mailing Address
First Line : 6636 CROSSBRIDGE DR
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46062-7361
Country : US
Telephone Number : 317-773-3963
Fax Number :
Provider Business Practice Location Address
First Line : 1500 NORTH RITTER AVENUE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-3027
Country : US
Telephone Number : 317-355-2560
Fax Number : 317-351-2418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2007
Last Update Date : 08/28/2012

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