Provider Demographics
NPI:1548402829
Name:BENNETT, PAULA THERESA (LPC-S)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:THERESA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2325
Mailing Address - Country:US
Mailing Address - Phone:940-781-1379
Mailing Address - Fax:
Practice Address - Street 1:3505 HARRISON ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2325
Practice Address - Country:US
Practice Address - Phone:940-781-1379
Practice Address - Fax:940-397-3150
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional