Provider Demographics
NPI:1194189274
Name:BENNETT, CRYSTAL (LPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 S HERITAGE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5916
Mailing Address - Country:US
Mailing Address - Phone:480-861-9400
Mailing Address - Fax:
Practice Address - Street 1:1220 S ALMA SCHOOL RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2078
Practice Address - Country:US
Practice Address - Phone:602-291-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional