Provider Demographics
NPI:1528325784
Name:BENNETT, JOHN WILLIAM JR (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAM
Last Name:BENNETT
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E LIBERTY ST
Mailing Address - Street 2:SUITE 287
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2119
Mailing Address - Country:US
Mailing Address - Phone:734-668-8335
Mailing Address - Fax:866-727-5331
Practice Address - Street 1:255 E LIBERTY ST
Practice Address - Street 2:SUITE 287
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2119
Practice Address - Country:US
Practice Address - Phone:734-668-8335
Practice Address - Fax:866-727-5331
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801014325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health