Provider Demographics
NPI:1942848940
Name:BANTA COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:BANTA COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:DAVENPORT
Authorized Official - Last Name:BANTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:717-503-5909
Mailing Address - Street 1:218 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2904
Mailing Address - Country:US
Mailing Address - Phone:717-503-5909
Mailing Address - Fax:
Practice Address - Street 1:3461 MARKET ST STE 104
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4412
Practice Address - Country:US
Practice Address - Phone:717-503-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty