Emily Bennett

Individual provider Active NPI Behavior Technician · Gulfport, MS

NPI 1104753896 · NPPES record last updated May 6, 2026

Key facts

NPI
1104753896
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
9480 Three Rivers Rd
Gulfport, MS 39503-4248
Phone
(228) 313-3106
NPI assigned
May 6, 2026
Sex
Unspecified or another gender identity
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

9480 Three Rivers Rd
Gulfport, MS 39503-4248

Mailing address

9480 Three Rivers Rd
Gulfport, MS 39503-4248

Other providers in Gulfport, MS

All providers in Gulfport, MS · Behavior Technician in Mississippi

Sources for this page

Verify at the official NPI Registry.