Provider Demographics
NPI:1417300526
Name:BENTLEY FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:BENTLEY FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-552-5559
Mailing Address - Street 1:PO BOX 2311
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-2311
Mailing Address - Country:US
Mailing Address - Phone:972-552-5559
Mailing Address - Fax:972-552-5499
Practice Address - Street 1:713 W BROAD ST
Practice Address - Street 2:200
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9147
Practice Address - Country:US
Practice Address - Phone:972-552-5559
Practice Address - Fax:972-552-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty