Active NPI
Kendra Caroline Bennett, LPC - SUPERVISOR
- Counselor
- Longview, TX
National Provider Identifier
1417719154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 72450
- Practice address
- 107 Community Blvd Ste 2
Longview, TX 75605-6186 - Phone
- (903) 590-7723
- NPI assigned
- Jan 29, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 72450 | TX | Primary |
Addresses
Primary practice location
107 Community Blvd Ste 2
Longview, TX 75605-6186
Mailing address
3635 County Road 334
Tyler, TX 75708-2726
Phone (903) 590-7723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72450 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706486400000",
"number": "1417719154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3635 COUNTY ROAD 334",
"city": "TYLER",
"state": "TX",
"postal_code": "757082726",
"telephone_number": "903-590-7723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 COMMUNITY BLVD STE 2",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756056186",
"telephone_number": "903-590-7723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "KENDRA",
"middle_name": "CAROLINE",
"credential": "LPC - SUPERVISOR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-29",
"last_updated": "2024-01-29",
"certification_date": "2024-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "72450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.