Provider Demographics
NPI:1134307580
Name:BENNETT, SALLYE J (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SALLYE
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 HAVENBROOK ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4102
Mailing Address - Country:US
Mailing Address - Phone:405-329-0101
Mailing Address - Fax:405-329-1768
Practice Address - Street 1:3401 HAVENBROOK ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4102
Practice Address - Country:US
Practice Address - Phone:405-329-0101
Practice Address - Fax:405-329-1768
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist