Provider Demographics
NPI:1235746538
Name:BENNETT, MARION (PHD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC-S
Mailing Address - Street 1:7106 TWILIGHT MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-3524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:916 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5210
Practice Address - Country:US
Practice Address - Phone:817-371-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional