Provider Demographics
NPI:1275794323
Name:BENTLEY, LANA L (MC, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:L
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:MC, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21953
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-1953
Mailing Address - Country:US
Mailing Address - Phone:602-571-7998
Mailing Address - Fax:
Practice Address - Street 1:3840 E RAY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7180
Practice Address - Country:US
Practice Address - Phone:602-571-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 10801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional