Provider Demographics
NPI:1033853890
Name:BANTA, MONIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:BANTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58535 SAINT CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3531
Mailing Address - Country:US
Mailing Address - Phone:225-776-9123
Mailing Address - Fax:225-289-4318
Practice Address - Street 1:23520 EDEN ST STE C
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-2750
Practice Address - Country:US
Practice Address - Phone:225-289-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health