Provider Demographics
NPI:1578234340
Name:BENNETT, ANGELICA MARIA (LPC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:MARIA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 PONDEROSA LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6835
Mailing Address - Country:US
Mailing Address - Phone:602-717-2831
Mailing Address - Fax:
Practice Address - Street 1:463 S LAKE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-0856
Practice Address - Country:US
Practice Address - Phone:480-528-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional