Provider Demographics
NPI:1992562417
Name:BENNETT, EMILY JO (PLPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JO
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 NE CHIPMAN RD APT 74
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2581
Mailing Address - Country:US
Mailing Address - Phone:816-304-6513
Mailing Address - Fax:
Practice Address - Street 1:105C W WALL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2355
Practice Address - Country:US
Practice Address - Phone:816-974-7378
Practice Address - Fax:816-817-1619
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024007350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional