Individual
MR. CHRISTOPHER JOSEPH BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA PSYCHOLOGY
Contact information
Practice address
218 DIVIDEND DR STE 3, REXBURG, ID 83440-3510
(208) 359-9683
Mailing address
635 ANGELA DR, REXBURG, ID 83440-1422
(208) 351-0149
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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