Individual
KELLY MARIE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1500 NORTH RITTER AVENUE, INDIANAPOLIS, IN 46219-3027
(317) 355-2560
(317) 351-2418
Mailing address
6636 CROSSBRIDGE DR, NOBLESVILLE, IN 46062-7361
(317) 773-3963
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002205A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270530
—
IN
Enumeration date
02/23/2007
Last updated
08/28/2012
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