Provider Demographics
NPI:1508412834
Name:BENNETT, MARY FRANCES (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 TIBBETS DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6914
Mailing Address - Country:US
Mailing Address - Phone:817-848-7723
Mailing Address - Fax:
Practice Address - Street 1:4000 HULEN PL APT 231
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7373
Practice Address - Country:US
Practice Address - Phone:662-822-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78829101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty