MEDICARE: MICHAEL 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	101YP2500X	Professional Counselor	278538	KY

General Provider Information

NPI Number	:	1891337622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BENNETT

Provider Business Mailing Address
First Line	:	204 N. LEXINGTON AVE
Second Line	:
City	:	WILMORE
State	:	KS
Zip	:	40390
Country	:	US
Telephone Number	:	904-568-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 CODELL DR STE 230
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1178
Country	:	US
Telephone Number	:	859-309-2877
Fax Number	:

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

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	05/01/2024

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Directions to “ MICHAEL BENNETT ” Practice Location

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