Provider Demographics
NPI:1023150901
Name:BENNETT, KENNETH ALVIN JR (LCSW, CART)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALVIN
Last Name:BENNETT
Suffix:JR
Gender:M
Credentials:LCSW, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S INDUSTRIAL BLVD
Mailing Address - Street 2:307
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-5048
Mailing Address - Country:US
Mailing Address - Phone:817-917-2335
Mailing Address - Fax:
Practice Address - Street 1:610 S INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-5048
Practice Address - Country:US
Practice Address - Phone:817-917-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical