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1528804523 NPI number — THOMAS PATRICK BANTA LCAC

NPI Number: 1528804523
Health Care Provider/Practitioner: THOMAS PATRICK BANTA LCAC

Information about “1528804523” NPI (THOMAS PATRICK BANTA LCAC) exists in 1528804523 in HTML format HTML  |  1528804523 in plain Text format TXT  |  1528804523 in PDF (Portable Document Format) PDF  |  1528804523 in an XML format XML  formats.

NPI Number : 1528804523 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528804523",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BANTA",
    "FirstName": "THOMAS",
    "MiddleName": "PATRICK",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BANTA",
    "OtherFirstName": "THOMAS",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCAC",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 776351",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60677-6351",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-588-9490",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1220 MISSOURI AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JEFFERSONVILLE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47130-3725",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-283-2217",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/08/2024",
    "LastUpdateDate": "10/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "88001398A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "87001744A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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