Provider Demographics
NPI:1053502575
Name:BENNETT, EMILY CHRISTINE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CHRISTINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:CHRISTINE
Other - Last Name:CRIPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:5403 MILHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-4164
Mailing Address - Country:US
Mailing Address - Phone:317-258-5169
Mailing Address - Fax:
Practice Address - Street 1:2345 S LYNHURST DR STE 205
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5100
Practice Address - Country:US
Practice Address - Phone:317-247-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN974052101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool