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Individual
RANDALL E BENNETT
Active
Individual
RANDALL E BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC,LMFT
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180-002128
IL
106H00000X
Marriage & Family Therapist
166-000313
IL
Other
Enumeration date
08/30/2006
Last updated
07/14/2016
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