Provider Demographics
NPI:1982017828
Name:BENNETT, KELSEY ANN
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S CHARLES ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6891
Mailing Address - Country:US
Mailing Address - Phone:352-223-5436
Mailing Address - Fax:
Practice Address - Street 1:306 S CHARLES ST APT 6
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6891
Practice Address - Country:US
Practice Address - Phone:352-223-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist