Individual
KELLY RANDOLPH BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
578 VIA ARISTA, SANTA FE, NM 87506-4507
(505) 577-1862
(505) 466-9459
Mailing address
PO BOX 9880, SANTA FE, NM 87504-9880
(505) 577-1862
(505) 466-9459
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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