MEDICARE: GARY BENTLEY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1336688787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY BENTLEY

Provider Business Mailing Address
First Line	:	1919 FRANKLIN AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-7603
Country	:	US
Telephone Number	:	504-947-4443
Fax Number	:	504-947-4443

Provider Business Practice Location Address
First Line	:	1919 FRANKLIN AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-7603
Country	:	US
Telephone Number	:	504-947-4443
Fax Number	:	504-947-4443

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

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	02/17/2017

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Directions to “ GARY BENTLEY ” Practice Location

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