Individual
MR. BRANDON LEE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
1443 N ROBBERSON AVE, SPRINGFIELD, MO 65802-3840
(417) 761-5848
(417) 761-5861
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2018006693
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490056364
—
MO
Enumeration date
02/21/2018
Last updated
11/10/2023
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