Provider Demographics
NPI:1982612388
Name:BENNETT, THERESA SLAUGHTER (LCSW)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:SLAUGHTER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 JENNY SLIPPER DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-4701
Mailing Address - Country:US
Mailing Address - Phone:504-232-5100
Mailing Address - Fax:504-226-5035
Practice Address - Street 1:106 W CENTRAL AVE STE 112
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3079
Practice Address - Country:US
Practice Address - Phone:504-232-5100
Practice Address - Fax:504-226-5035
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44401041C0700X
TX634851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982612388OtherHUMANA MILITARY - TRICARE EAST
LA600568651OtherMAGELLAN
LA2404385Medicaid
TX2429553OtherCIGNA EVERNORTH, TELEHEALTH ONLY, TX
267172OtherTRICARE STANDARD
TX587803OtherBEACON/VALUEOPTIONS/MILITARYONESOURCE
TX1982612388OtherPGBA TRIWEST VA CCN
H000033NUOtherBLUE CROSS BLUE SHIELD OF TX