MEDICARE: MS. WENDY CHASE BENNETT MS, MA LMHC

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	MH 11287	FL

General Provider Information

NPI Number	:	1669637021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY CHASE BENNETT MS, MA LMHC

Provider Business Mailing Address
First Line	:	1170 WOODLAND TERRACE TRL
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1808
Country	:	US
Telephone Number	:	407-300-8316
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 DOUGLAS AVE
Second Line	:	SUITE 3303
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2064
Country	:	US
Telephone Number	:	407-300-8316
Fax Number	:

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

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	06/18/2012

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