Healthcare Provider Details

I. General information

NPI: 1457285652
Provider Name (Legal Business Name): EMMET BANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 CANAL ST
NEW ORLEANS LA
70119-5851
US

IV. Provider business mailing address

4710 CANAL ST
NEW ORLEANS LA
70119-5851
US

V. Phone/Fax

Practice location:
  • Phone: 504-298-9346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11272
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: