Healthcare Provider Details

I. General information

NPI: 1700991882
Provider Name (Legal Business Name): DANIEL LEE BANEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 PARKDALE PL STE C
INDIANAPOLIS IN
46254-6602
US

IV. Provider business mailing address

6825 PARKDALE PL STE C
INDIANAPOLIS IN
46254-6602
US

V. Phone/Fax

Practice location:
  • Phone: 317-981-5418
  • Fax: 317-981-5429
Mailing address:
  • Phone: 317-981-5418
  • Fax: 317-981-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number200400759A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: