Individual
MR. MARK CODY BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC U/S, CADC
Contact information
Practice address
3033 N WALNUT AVE, OKLAHOMA CITY, OK 73105-2832
(405) 230-1145
(405) 552-2611
Mailing address
1216 MOCKINGBIRD LN, EDMOND, OK 73034-5788
(405) 285-7605
(405) 552-2611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
09/01/2009
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