Provider Demographics
NPI:1407221617
Name:BENNETT, MINETTE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MINETTE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4898 FOX LN S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9726
Mailing Address - Country:US
Mailing Address - Phone:503-509-7413
Mailing Address - Fax:503-694-7794
Practice Address - Street 1:3295 TRIANGLE DR SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4566
Practice Address - Country:US
Practice Address - Phone:503-509-7413
Practice Address - Fax:503-694-7794
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5716101YP2500X
ORR4808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional