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General NPI Number Information
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NPI Number | 1417814245
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Entity Type | Individual
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Provider Name | ROBERTA G BANNISTER CHT
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 23394 KNAPPS CUTOFF # 4387
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City | CRESTLINE
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State | CA
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Zip | 92325-9427
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Country | US
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Telephone | 840-210-1763
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4387
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City | CRESTLINE
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State | CA
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Zip | 92325-4387
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Country | US
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Telephone | 840-210-1763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State | CA
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