Individual provider · NPI-1

Lisa Ann Bennett, MS

Counselor, Mental Health · Mattoon, IL

NPI number1467026641
StatusActive
Last updated in NPPESMay 13, 2021

Details

NPI
1467026641
Entity type
Individual (NPI-1)
Name
Lisa Ann Bennett
Credential
MS
Sex
Female
Sole proprietor
No
Enumeration date
May 13, 2021
Certification date
May 13, 2021
Last updated
May 13, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YM0800X Counselor, Mental Health––Yes

Practice location

750 Broadway Ave E
Mattoon, IL 61938-4610

Phone 217-238-5735

Mailing address

750 Broadway Ave E
Mattoon, IL 61938-4610

Phone 217-238-5735

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