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General NPI Number Information
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NPI Number | 1700306503
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Entity Type | Organization
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Legal Business Name | BETSY BENNETT, LLC
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 821 W SOUTH ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-4684
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Country | US
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Telephone | 269-303-2302
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 LAKE FOREST LN
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City | KALAMAZOO
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State | MI
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Zip | 49008-3380
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Country | US
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Telephone | 269-303-2302
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETSY BENNETT
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Credential | LCSW
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Telephone | 269-303-2302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093831
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License Number State | MI
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