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1194034454
GREGORY JAMES BENNETT
POWELL, WY
NPI
1194034454
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: WY LAT326)
Enumeration Date
2010-10-04
Last Update Date
2015-02-25
Business Address
GREGORY JAMES BENNETT LAT
249 E 2ND ST STE 1
POWELL, WY 82435-1959
Phone number: 307-254-2038
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Mailing Address
GREGORY JAMES BENNETT LAT
1051 MORNING GLORY LN
POWELL, WY 82435-2266
Phone number: 307-254-2038
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