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Individual

MATTHEW BANAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
750 VETERANS PKWY UNIT 100, LAKE GENEVA, WI 53147-4950
(262) 248-7942
Mailing address
40723 93RD ST, GENOA CITY, WI 53128-1291
(219) 476-5863

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
09/10/2020
Last updated
09/16/2021
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