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General NPI Number Information
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NPI Number | 1316149792
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Entity Type | Individual
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Provider Name | MATTHEW SCOTT BENNETT PHD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1222 S VISTA AVE
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City | BOISE
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State | ID
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Zip | 83705-2530
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Country | US
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Telephone | 208-837-5121
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Fax | 208-906-8234
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Provider Business Mailing Address
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Address Line | 1222 S VISTA AVE
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City | BOISE
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State | ID
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Zip | 83705-2530
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Country | US
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Telephone | 208-837-5121
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Fax | 208-906-8234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 394
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License Number State | ND
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