Individual
KELLY RANDOLPH BENNETT
Active
Individual
KELLY RANDOLPH BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LPCC 0088061
NM
103TC1900X
Counseling Psychologist
MFC 2017
CA
Other
Enumeration date
12/06/2007
Last updated
04/07/2008
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