Provider Demographics
NPI:1386995033
Name:BENNETT, DIONNE SURRELLA
Entity type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:SURRELLA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 NW 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-5114
Mailing Address - Country:US
Mailing Address - Phone:310-619-1416
Mailing Address - Fax:
Practice Address - Street 1:1308 NW 105TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-5114
Practice Address - Country:US
Practice Address - Phone:310-619-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional