Provider Demographics
NPI:1700952207
Name:BENTLEY, MORRIS MICHEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:MICHEL
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-0145
Mailing Address - Country:US
Mailing Address - Phone:208-983-5535
Mailing Address - Fax:208-983-5575
Practice Address - Street 1:365 CENTER ROAD
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-0145
Practice Address - Country:US
Practice Address - Phone:208-983-5535
Practice Address - Fax:208-983-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical