Provider Demographics
NPI:1043640212
Name:BENNETT, JENA (MA)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 W HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-8207
Mailing Address - Country:US
Mailing Address - Phone:817-517-4436
Mailing Address - Fax:
Practice Address - Street 1:5804 W HWY 67
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-8207
Practice Address - Country:US
Practice Address - Phone:817-517-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional