Provider Demographics
NPI:1154653731
Name:BENNETT, DEWONE EVERETT JR (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:DEWONE
Middle Name:EVERETT
Last Name:BENNETT
Suffix:JR
Gender:M
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12700 PRESTON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6601
Mailing Address - Country:US
Mailing Address - Phone:469-705-9914
Mailing Address - Fax:972-233-9799
Practice Address - Street 1:12700 PRESTON RD STE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6601
Practice Address - Country:US
Practice Address - Phone:469-705-9914
Practice Address - Fax:972-233-9799
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200364360BMedicaid
TX78289OtherLPC-S