| Judy Bannister, Llc | |
|
5455 W 86th St Ste 102 Indianapolis IN 46268-1536 | |
| (317) 762-0888 | |
| Not Available |
| Full Name | Judy Bannister, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5455 W 86th St Ste 102, Indianapolis, Indiana |
| Authorized Official Name and Position | Judy A Bannister (OWNER/PRESIDENT) |
| Authorized Official Contact | 3176709413 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Judy Bannister, Llc 5455 W 86th St Ste 102 Indianapolis IN 46268-1536 Ph: (317) 762-0888 | Judy Bannister, Llc 5455 W 86th St Ste 102 Indianapolis IN 46268-1536 Ph: (317) 762-0888 |
| NPI Number | 1225404544 |
|---|---|
| Provider Enumeration Date | 08/20/2015 |
| Last Update Date | 07/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225404544 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 87001400A (Indiana) | Secondary |
| 1041C0700X | Social Worker - Clinical | 34004283A (Indiana) | Primary |
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