Provider Demographics
NPI:1447947460
Name:BENNETT, NAYARA
Entity type:Individual
Prefix:
First Name:NAYARA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAYARA
Other - Middle Name:
Other - Last Name:XAVIER DE OLIVEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9108 LAKEWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3949
Mailing Address - Country:US
Mailing Address - Phone:253-581-6202
Mailing Address - Fax:
Practice Address - Street 1:9108 LAKEWOOD DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3949
Practice Address - Country:US
Practice Address - Phone:253-581-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor