Provider Demographics
NPI:1619536125
Name:BENNETT, COURTNEY A (ACMHC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S 1080 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5257
Mailing Address - Country:US
Mailing Address - Phone:208-240-3751
Mailing Address - Fax:
Practice Address - Street 1:376 E 400 S STE 4
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1987
Practice Address - Country:US
Practice Address - Phone:801-885-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11332443-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health