Healthcare Provider Details

I. General information

NPI: 1316651896
Provider Name (Legal Business Name): REBECCA K BENNETT MA, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E 29TH ST
TACOMA WA
98404-4004
US

IV. Provider business mailing address

1712 6TH AVE SUITE 100 PMB 1112
TACOMA WA
98405-3300
US

V. Phone/Fax

Practice location:
  • Phone: 657-401-7646
  • Fax:
Mailing address:
  • Phone: 657-401-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61548302
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: