Provider Demographics
NPI:1437493822
Name:BENNETT-KINNEY, CHARITY (PHD, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:
Last Name:BENNETT-KINNEY
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 COUNTY ROAD 4101
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-8333
Mailing Address - Country:US
Mailing Address - Phone:806-206-2385
Mailing Address - Fax:903-628-0687
Practice Address - Street 1:1608 COUNTY ROAD 4101
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-8333
Practice Address - Country:US
Practice Address - Phone:806-206-2385
Practice Address - Fax:903-628-0687
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional