Healthcare Provider Details

I. General information

NPI: 1114136199
Provider Name (Legal Business Name): GINGER BENNETT MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 SAINT PAUL ST
BILOXI MS
39530-3513
US

IV. Provider business mailing address

179 SAINT PAUL ST
BILOXI MS
39530-3513
US

V. Phone/Fax

Practice location:
  • Phone: 228-435-0187
  • Fax: 228-374-1586
Mailing address:
  • Phone: 228-435-0187
  • Fax: 228-374-1586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: