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MR. JEFFREY L BENNETT LCSW

Behavioral Health & Social Service Providers Counselor Professional

Provider NPI: 1740214089

Provider Information:
MR. JEFFREY L BENNETT LCSW
Gender: M
Not Sole Proprietor

Practice Location:
1600 BROAD AVE  GULFPORT, MS 39501-3603 US
Tel: 228-863-1132  Fax: 228-865-1700

Business Mailing Address:
1600 BROAD AVE  GULFPORT, MS 39501-3603 US
Tel: 228-863-1132  Fax: 228-865-1700

NPI Information:
NPI: 1740214089
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YP2500XBehavioral Health & Social Service Providers
Counselor
Professional
MSC0580

Other Provider Identifiers:

IssuerNumberStateType
00018213MS05



American Medical Association 2012 taxonomy code information

Code: 101YP2500X

Type:

Classification:



Definition:



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