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General NPI Number Information
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NPI Number | 1649780214
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Entity Type | Organization
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Legal Business Name | BENTLEY WELLNESS ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 9542 BROOKLINE AVE STE F
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City | BATON ROUGE
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State | LA
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Zip | 70809-1492
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Country | US
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Telephone | 225-960-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 12316 E BROCK PL
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City | BATON ROUGE
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State | LA
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Zip | 70807-1903
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Country | US
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Telephone | 225-315-3568
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ROBYN BENTLEY
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Credential | LPC
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Telephone | 225-315-3568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5255
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License Number State | LA
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