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General NPI Number Information
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NPI Number | 1982612388
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Entity Type | Individual
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Provider Name | THERESA SLAUGHTER BENNETT LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 106 W CENTRAL AVE STE 112
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City | BELTON
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State | TX
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Zip | 76513-3079
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Country | US
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Telephone | 504-232-5100
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Fax | 504-226-5035
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Provider Business Mailing Address
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Address Line | 3663 JENNY SLIPPER DR
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City | BELTON
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State | TX
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Zip | 76513-4701
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Country | US
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Telephone | 504-232-5100
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Fax | 504-226-5035
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4440
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 63485
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License Number State | TX
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