| Bennett Creek Therapy, Llc | |
|
650 Bennett Creek Rd Cottage Grove OR 97424-1007 | |
| (541) 556-4606 | |
| (541) 403-9893 |
| Full Name | Bennett Creek Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 650 Bennett Creek Rd, Cottage Grove, Oregon |
| Authorized Official Name and Position | Anjanette Tuckman (OWNER) |
| Authorized Official Contact | 5415564606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bennett Creek Therapy, Llc 650 Bennett Creek Rd Cottage Grove OR 97424-1007 Ph: (541) 556-4606 | Bennett Creek Therapy, Llc 650 Bennett Creek Rd Cottage Grove OR 97424-1007 Ph: (541) 556-4606 |
| NPI Number | 1720793482 |
|---|---|
| Provider Enumeration Date | 01/17/2023 |
| Last Update Date | 01/17/2023 |
| Certification Date | 01/17/2023 |
| Medicare PECOS PAC ID | 6204200785 |
|---|---|
| Medicare Enrollment ID | O20230323002585 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720793482 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Anjanette N Tuckman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780085852 PECOS PAC ID: 2062758766 Enrollment ID: I20190117001564 |
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