Provider Demographics
NPI:1457688582
Name:BENNETT, HEIDI J (MS PSYC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 E IRONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85708-1217
Mailing Address - Country:US
Mailing Address - Phone:520-300-5699
Mailing Address - Fax:
Practice Address - Street 1:5741 E IRONWOOD ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85708-1217
Practice Address - Country:US
Practice Address - Phone:520-300-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool