Healthcare Provider Details

I. General information

NPI: 1992562417
Provider Name (Legal Business Name): EMILY JO BENNETT PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105C W WALL ST
HARRISONVILLE MO
64701-2355
US

IV. Provider business mailing address

506 NE CHIPMAN RD APT 74
LEES SUMMIT MO
64063-2581
US

V. Phone/Fax

Practice location:
  • Phone: 816-974-7378
  • Fax: 816-817-1619
Mailing address:
  • Phone: 816-304-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024007350
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: