Individual
GREGORY JAMES BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
249 E 2ND ST STE 1, POWELL, WY 82435-1959
(307) 254-2038
Mailing address
1051 MORNING GLORY LN, POWELL, WY 82435-2266
(307) 254-2038
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAT326
WY
Other
Enumeration date
10/04/2010
Last updated
02/25/2015
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