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General NPI Number Information
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NPI Number | 1902915861
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Entity Type | Individual
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Provider Name | JACK BANNIN LMFT, LPC
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 11230 WEST AVE STE 1203
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1359
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Country | US
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Telephone | 210-320-2999
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Fax | 210-320-4716
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Provider Business Mailing Address
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Address Line | 15403 AIROLE WAY
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City | SAN ANTONIO
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State | TX
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Zip | 78232-4013
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Country | US
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Telephone | 210-825-9969
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 5072
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 18744
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License Number State | TX
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