Provider Demographics
NPI:1568526044
Name:BANISTER, JAN DENEAN (LPC, LPC/S)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:DENEAN
Last Name:BANISTER
Suffix:
Gender:F
Credentials:LPC, LPC/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 ANDERSON STREET SUITE B
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-2148
Mailing Address - Country:US
Mailing Address - Phone:864-933-0793
Mailing Address - Fax:800-340-0223
Practice Address - Street 1:716 ANDERSON STREET SUITE B
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-2148
Practice Address - Country:US
Practice Address - Phone:864-933-0793
Practice Address - Fax:800-340-0223
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC3524101Y00000X
SC3524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1336Medicaid
421504Medicare ID - Type Unspecified