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General NPI Number Information
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NPI Number | 1891337622
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Entity Type | Individual
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Provider Name | MICHAEL BENNETT
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Gender | Male
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 80 CODELL DR STE 230
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City | LEXINGTON
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State | KY
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Zip | 40509-1178
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Country | US
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Telephone | 859-309-2877
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N. LEXINGTON AVE
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City | WILMORE
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State | KS
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Zip | 40390
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Country | US
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Telephone | 904-568-0838
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 278538
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License Number State | KY
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