Provider Demographics
NPI:1700991882
Name:BANEY, DANIEL LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:BANEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 PARKDALE PL STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6602
Mailing Address - Country:US
Mailing Address - Phone:317-981-5418
Mailing Address - Fax:317-981-5429
Practice Address - Street 1:6825 PARKDALE PL STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6602
Practice Address - Country:US
Practice Address - Phone:317-981-5418
Practice Address - Fax:317-981-5429
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN200400759A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
200450AOtherMEDICARE
IN000000209316OtherBLUE CROSS/BLUE SHIELD
IN113340000OtherMAGELLAN PIN #
IN200383710AMedicaid
IN066606OtherVALUE OPTIONS PROVIDER #
IN2090807OtherCIGNA PROVIDER NUMBER