Healthcare Provider Details

I. General information

NPI: 1851786479
Provider Name (Legal Business Name): BENNETT COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E SKELLY DR SUITE 211-1
TULSA OK
74105-6317
US

IV. Provider business mailing address

PO BOX 582123
TULSA OK
74158-2123
US

V. Phone/Fax

Practice location:
  • Phone: 918-219-3123
  • Fax:
Mailing address:
  • Phone: 918-219-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BEVERLY P. BENNETT
Title or Position: FOUNDER
Credential: LPC, NCC
Phone: 918-219-3123