Provider Demographics
NPI:1053068346
Name:BENNERS, WENDY (MABC, LPC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BENNERS
Suffix:
Gender:F
Credentials:MABC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8456
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75607-8456
Mailing Address - Country:US
Mailing Address - Phone:903-720-7301
Mailing Address - Fax:
Practice Address - Street 1:1221 JUDSON RD STE 900
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3922
Practice Address - Country:US
Practice Address - Phone:903-720-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81956101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional