Individual
MR. GREGORY M. BANICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S. ED.
Contact information
Practice address
1910 SAINT JOE CENTER RD, FORT WAYNE, IN 46825-5000
(260) 484-5599
(260) 484-5664
Mailing address
1910 SAINT JOE CENTER RD, FORT WAYNE, IN 46825-5000
(260) 484-5599
(260) 484-5664
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/12/2006
Last updated
07/08/2007
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