Provider Demographics
NPI:1811472418
Name:BENNETT, JEFFREY SCOTT
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3405
Mailing Address - Country:US
Mailing Address - Phone:816-221-0305
Mailing Address - Fax:816-221-9121
Practice Address - Street 1:2029 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3405
Practice Address - Country:US
Practice Address - Phone:816-221-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health