Provider Demographics
NPI:1659006922
Name:BANNERMAN, BIANCA JORDAN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:JORDAN
Last Name:BANNERMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S DETROIT ST APT 307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3665
Mailing Address - Country:US
Mailing Address - Phone:301-356-4989
Mailing Address - Fax:
Practice Address - Street 1:4034 IRVING PL
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2810
Practice Address - Country:US
Practice Address - Phone:310-842-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT131139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist