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Individual

MRS. KELLY S BENEDICT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.

Contact information

Practice address
720 N MARR RD, COLUMBUS, IN 47201-6660
(812) 314-3400
(812) 378-8367
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
(812) 378-8367

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35000784A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000222727
ANTHEM PIN #
IN
05
100177270A
IN
01
278804000
MAGELLAN PIN#
IN
01
7075431
AETNA PIN
IN
Enumeration date
10/12/2006
Last updated
04/03/2024
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