MEDICARE: AHMAD BENNETT MA, LMFTA,MHP

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	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist
3	106H00000X	Marriage & Family Therapist	MG61212578	WA

General Provider Information

NPI Number	:	1194343244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMAD BENNETT MA, LMFTA,MHP

Provider Business Mailing Address
First Line	:	5115 N CALVIN RD
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-3000
Country	:	US
Telephone Number	:	509-795-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 N CALVIN RD
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-3000
Country	:	US
Telephone Number	:	509-795-0036
Fax Number	:

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

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	08/25/2022

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