Healthcare Provider Details

I. General information

NPI: 1871045534
Provider Name (Legal Business Name): STUART BENNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44350 SE WARRINER RD
CORBETT OR
97019-9504
US

IV. Provider business mailing address

44350 SE WARRINER RD
CORBETT OR
97019-9504
US

V. Phone/Fax

Practice location:
  • Phone: 323-404-6981
  • Fax:
Mailing address:
  • Phone: 323-404-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: