Lydia Ruth Banton, LMHC | |
5470 East 16th Street, Indianapolis, IN 46218-4861 | |
(317) 355-5394 | |
(317) 351-7580 |
Full Name | Lydia Ruth Banton |
---|---|
Gender | Female |
Speciality | Counselor - Mental Health |
Location | 5470 East 16th Street, Indianapolis, Indiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1831353911 | NPI | - | NPPES |
100270530 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | 39002262A (Indiana) | Primary |
Entity Name | Sondermind Provider Network Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20210416002216 |
Mailing Address | Practice Location Address |
---|---|
Lydia Ruth Banton, LMHC 6626 E 75th Street, Suite 500, Indianapolis, IN 46250-2890 Ph: (317) 621-7561 | Lydia Ruth Banton, LMHC 5470 East 16th Street, Indianapolis, IN 46218-4861 Ph: (317) 355-5394 |
Miss Tangela Cameron, B.S. Counselor Medicare: Not Enrolled in Medicare Practice Location: 2626 E 46th St, Indianapolis, IN 46205 Phone: 317-475-9066 Fax: 317-257-3602 | |
Elizabeth J Malcom, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 8401 Harcourt Rd, Indianapolis, IN 46260 Phone: 317-338-4600 Fax: 317-338-4890 | |
Molly Tompkins, Counselor Medicare: Not Enrolled in Medicare Practice Location: 2626 E 46th St, Ste J, Indianapolis, IN 46205 Phone: 317-475-9066 | |
Marlene J Villecco, MS, LCAC Counselor Medicare: Not Enrolled in Medicare Practice Location: 5638 Professional Cir, Indianapolis, IN 46241 Phone: 888-714-1927 Fax: 317-247-8935 | |
Camishe R Nunley, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 5502 East 16th Street, Suite A 31, Indianapolis, IN 46218 Phone: 317-355-1800 | |
Mrs. Unchana Thamasak, M.S Counselor Medicare: Not Enrolled in Medicare Practice Location: 3905 Vincennes Rd, Suite 303, Indianapolis, IN 46268 Phone: 317-471-3522 Fax: 317-471-3508 | |
Mark P Radel, MA Counselor Medicare: Not Enrolled in Medicare Practice Location: 2011 N Meridian St, Indianapolis, IN 46202 Phone: 317-924-7010 Fax: 317-941-2208 |