MEDICARE: HOLLY BENNINGFIELD M.A., LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	164713	KY

General Provider Information

NPI Number	:	1073066486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY BENNINGFIELD M.A., LPCA

Provider Business Mailing Address
First Line	:	112 E MCMURTRY AVE
Second Line	:	STE. 107
City	:	HARTFORD
State	:	KY
Zip	:	42347-1634
Country	:	US
Telephone Number	:	270-298-3461
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 E MCMURTRY AVE
Second Line	:	STE. 107
City	:	HARTFORD
State	:	KY
Zip	:	42347-1634
Country	:	US
Telephone Number	:	270-298-3461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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