Healthcare Provider Details

I. General information

NPI: 1598435455
Provider Name (Legal Business Name): COURTNEY BENNETT LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD STE 311
LANSING MI
48910-6821
US

IV. Provider business mailing address

812 E JOLLY RD STE 311
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8000
  • Fax:
Mailing address:
  • Phone: 517-346-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: