Provider Demographics
NPI:1700366085
Name:BENNETT, TERESEA L (LMSW, LCAC)
Entity Type:Individual
Prefix:
First Name:TERESEA
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMSW, LCAC
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, LCAC
Mailing Address - Street 1:1917 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ELLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67637-1905
Mailing Address - Country:US
Mailing Address - Phone:785-623-3482
Mailing Address - Fax:
Practice Address - Street 1:2501 E 13TH
Practice Address - Street 2:BUILDING 3 SUITE 10
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-3573
Practice Address - Fax:785-621-2257
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS103101YA0400X
KS10020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)