Provider Demographics
NPI:1992198543
Name:BANYAN GROUP
Entity Type:Organization
Organization Name:BANYAN GROUP
Other - Org Name:THE BANYAN GROUP, INC., COUNSELING, COACHING AND CONSULTING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT; DIRECTOR OF COUNSELING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANECE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-845-4073
Mailing Address - Street 1:372 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2261
Mailing Address - Country:US
Mailing Address - Phone:951-845-4073
Mailing Address - Fax:201-353-8530
Practice Address - Street 1:372 E 7TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2261
Practice Address - Country:US
Practice Address - Phone:951-845-4073
Practice Address - Fax:201-353-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty