| Jeb Bennett Lcsw | |
|
800 Laramie Blvd Unit B Boulder CO 80304-4785 | |
| (303) 946-0236 | |
| Not Available |
| Full Name | Jeb Bennett Lcsw |
|---|---|
| Speciality | Counselor |
| Location | 800 Laramie Blvd Unit B, Boulder, Colorado |
| Authorized Official Name and Position | Gerald W Bennett (OWNER) |
| Authorized Official Contact | 3039460236 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeb Bennett Lcsw 800 Laramie Blvd Unit B Boulder CO 80304-4785 Ph: (303) 946-0236 | Jeb Bennett Lcsw 800 Laramie Blvd Unit B Boulder CO 80304-4785 Ph: (303) 946-0236 |
| NPI Number | 1538826573 |
|---|---|
| Provider Enumeration Date | 11/24/2021 |
| Last Update Date | 12/06/2021 |
| Certification Date | 12/02/2021 |
| Medicare PECOS PAC ID | 2264825934 |
|---|---|
| Medicare Enrollment ID | O20220202001795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538826573 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Gerald W Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922160134 PECOS PAC ID: 7214093418 Enrollment ID: I20090312000312 |
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