MEDICARE: MR. JAMES BENNETT

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	5807	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528475266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES BENNETT

Provider Business Mailing Address
First Line	:	289 HIGHWAY 90 E UNIT H
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9298
Country	:	US
Telephone Number	:	304-610-8661
Fax Number	:	843-695-7681

Provider Business Practice Location Address
First Line	:	289 HIGHWAY 90 E UNIT H
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9298
Country	:	US
Telephone Number	:	843-685-0998
Fax Number	:	843-695-7681

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	12/14/2018

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Directions to “ MR. JAMES BENNETT ” Practice Location

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