Provider Demographics
NPI:1972622983
Name:BENNETT, NANCY D (LMHC CDP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMHC CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 28TH AVE NE
Mailing Address - Street 2:STE 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5333
Mailing Address - Country:US
Mailing Address - Phone:425-776-8746
Mailing Address - Fax:206-440-3134
Practice Address - Street 1:15720 MAIN ST
Practice Address - Street 2:STE 241
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-776-8746
Practice Address - Fax:206-440-3134
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002691101YA0400X
WALH00003623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)