Provider Demographics
NPI:1083394498
Name:BENNETT, KATHERINE ELIZABETH (KATHERINE PLPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:KATHERINE PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-4613
Mailing Address - Country:US
Mailing Address - Phone:304-670-5203
Mailing Address - Fax:
Practice Address - Street 1:65 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-0258
Practice Address - Country:US
Practice Address - Phone:304-848-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health