Provider Demographics
NPI:1083858450
Name:LANI T. BENNETT, PH. , P.A.
Entity Type:Organization
Organization Name:LANI T. BENNETT, PH. , P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANI
Authorized Official - Middle Name:T
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:612-870-0230
Mailing Address - Street 1:484 NATURE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4459
Mailing Address - Country:US
Mailing Address - Phone:612-870-0230
Mailing Address - Fax:612-872-9170
Practice Address - Street 1:430 OAK GROVE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3253
Practice Address - Country:US
Practice Address - Phone:612-870-0230
Practice Address - Fax:612-872-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1729103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty