Individual
KELLY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5306 N 17TH AVE, PHOENIX, AZ 85015-3035
(602) 249-6674
(480) 422-0052
Mailing address
5306 N 17TH AVE, PHOENIX, AZ 85015-3035
(602) 249-6674
(480) 422-0052
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/28/2021
Last updated
12/28/2021
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