Provider Demographics
NPI:1033259783
Name:BANYAN INSTITUTE, INC
Entity Type:Organization
Organization Name:BANYAN INSTITUTE, INC
Other - Org Name:LISA C NIEBLING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NIEBLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, CST
Authorized Official - Phone:561-798-2310
Mailing Address - Street 1:11388 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8705
Mailing Address - Country:US
Mailing Address - Phone:561-798-2310
Mailing Address - Fax:561-798-2477
Practice Address - Street 1:11388 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8705
Practice Address - Country:US
Practice Address - Phone:561-798-2310
Practice Address - Fax:561-798-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-4160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty