1013336049 NPI number — JULIE LOREE BAXTER BENNETT M.S.; LPC

Table of content: JULIE LOREE BAXTER BENNETT M.S.; LPC (NPI 1013336049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013336049 NPI number — JULIE LOREE BAXTER BENNETT M.S.; LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
JULIE
Provider Middle Name:
LOREE BAXTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.; LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013336049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 E. HWY CC
Provider Second Line Business Mailing Address:
A105
Provider Business Mailing Address City Name:
NIXA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-725-8810
Provider Business Mailing Address Fax Number:
417-725-6202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 E. HWY CC
Provider Second Line Business Practice Location Address:
A105
Provider Business Practice Location Address City Name:
NIXA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-725-8810
Provider Business Practice Location Address Fax Number:
417-725-6202
Provider Enumeration Date:
04/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2012007307 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com