Individual
PHYLLIS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4105 KIRKMAN ST, LAKE CHARLES, LA 70607-4603
(337) 457-8022
Mailing address
2715 NOTTOWAY LN, LAKE CHARLES, LA 70605-4021
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
651
LA
Other
Enumeration date
02/05/2007
Last updated
07/08/2007
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