Individual
TYLER GATES BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(480) 536-3016
Mailing address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(480) 536-3016
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-16910
AZ
Other
Enumeration date
04/23/2019
Last updated
05/10/2019
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