Healthcare Provider Details

I. General information

NPI: 1942848940
Provider Name (Legal Business Name): BANTA COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 S ROUSE AVE
BOZEMAN MT
59715-5765
US

IV. Provider business mailing address

2002 S ROUSE AVE
BOZEMAN MT
59715-5765
US

V. Phone/Fax

Practice location:
  • Phone: 717-503-5909
  • Fax:
Mailing address:
  • Phone: 717-503-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KERRY DAVENPORT BANTA
Title or Position: OWNER
Credential: LPC, LCPC
Phone: 717-503-5909