Provider Demographics
NPI:1205275591
Name:BENNETT, ELISE (MS)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 N BELLEVIEW
Mailing Address - Street 2:SUITE 211
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-1502
Mailing Address - Country:US
Mailing Address - Phone:785-341-2977
Mailing Address - Fax:
Practice Address - Street 1:4444 N BELLEVIEW
Practice Address - Street 2:SUITE 211
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1502
Practice Address - Country:US
Practice Address - Phone:785-341-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE