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Organization

MARK BENNETT PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MARK BARRY BENNETT LCSW (CLINICAL SOCIAL WORKER)
(208) 521-9437
Entity
Organization

Contact information

Practice address
2775 CHANNING WAY, IDAHO FALLS, ID 83404-7510
(208) 524-0133
Mailing address
320 RED FOX DR, IDAHO FALLS, ID 83401-3479
(208) 521-9437

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
10/06/2021
Last updated
10/06/2021
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