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NPI Code Detail

MEDICARE: MRS. ANGELICA M BENNETT LPC, LCPC

MEDICARE: MRS. ANGELICA M BENNETT LPC, LCPC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1578234340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELICA M BENNETT LPC, LCPC
Provider Business Mailing Address
First Line : 968 FULL HOUSE LN
Second Line :
City : SHOW LOW
State : AZ
Zip : 85901-4042
Country : US
Telephone Number : 602-717-2831
Fax Number :
Provider Business Practice Location Address
First Line : 9610 N METRO PKWY W
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1402
Country : US
Telephone Number : 480-964-2273
Fax Number : 602-843-1560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2021
Last Update Date : 04/20/2026

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