Individual
MS. DURIE T BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LCPC
Contact information
Practice address
4501 RT 176, CRYSTAL LAKE, IL 60014
(815) 477-4003
Mailing address
4501 RT 176, CRYSTAL LAKE, IL 60014
(815) 477-4003
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5615166
BLUE CROSS
—
Enumeration date
12/15/2006
Last updated
07/08/2007
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