Individual
CANDACE D BENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, CCTP, EMDR
Contact information
Practice address
19871 SACKETT LN, WAYNESVILLE, MO 65583-3510
(573) 315-3848
(573) 312-3848
Mailing address
PO BOX 114, ROBY, MO 65557-0114
(573) 315-3848
(573) 312-3848
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2014034465
MO
101YP2500X
Professional Counselor
2014034465
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490021314
—
MO
Enumeration date
07/15/2014
Last updated
03/18/2024
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