Provider Demographics
NPI:1346520459
Name:BANAITIS INC.
Entity Type:Organization
Organization Name:BANAITIS INC.
Other - Org Name:LIMITLESS MINDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOESPH
Authorized Official - Last Name:BANAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:310-775-1521
Mailing Address - Street 1:12100 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7120
Mailing Address - Country:US
Mailing Address - Phone:310-775-1521
Mailing Address - Fax:424-238-8394
Practice Address - Street 1:12100 WILSHIRE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7120
Practice Address - Country:US
Practice Address - Phone:310-775-1521
Practice Address - Fax:424-238-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24542103K00000X
1041C0700X
CALMFT 47513106H00000X
CAMFC 44723106H00000X
CAPW5642252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
493372OtherMHN PROVIDER ID
CAA4793432OtherAETNA PROVIDER PIN
CAPW5642OtherDEPT. OF DEVELOPMENTAL SERVICES (HHS) AGENCY VENDOR NO.