| Tess Bennett Llc | |
|
1819 11th St Great Bend KS 67530-4511 | |
| (620) 603-6002 | |
| (620) 603-6529 |
| Full Name | Tess Bennett Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1819 11th St, Great Bend, Kansas |
| Authorized Official Name and Position | Teresea L Bennett (OWNER) |
| Authorized Official Contact | 6206036002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tess Bennett Llc 1819 11th St Great Bend KS 67530-4511 Ph: (620) 603-6002 | Tess Bennett Llc 1819 11th St Great Bend KS 67530-4511 Ph: (620) 603-6002 |
| NPI Number | 1770131468 |
|---|---|
| Provider Enumeration Date | 08/27/2019 |
| Last Update Date | 08/27/2019 |
| Medicare PECOS PAC ID | 4789914649 |
|---|---|
| Medicare Enrollment ID | O20190919002442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770131468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Teresea Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700366085 PECOS PAC ID: 0941530802 Enrollment ID: I20190919002575 |
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