Provider Demographics
NPI:1720621816
Name:BANASZEK, MARK (LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BANASZEK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9064 HELENA RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2737
Mailing Address - Country:US
Mailing Address - Phone:205-566-3241
Mailing Address - Fax:205-490-2303
Practice Address - Street 1:1957 HOOVER CT STE 307C
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-3622
Practice Address - Country:US
Practice Address - Phone:205-644-1166
Practice Address - Fax:205-490-2303
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional