Organization
JUDY BANNISTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY A BANNISTER LCSW, LCAC, SAP, NCC (OWNER/PRESIDENT)
(317) 670-9413
Entity
Organization
Contact information
Practice address
5455 W 86TH ST STE 102, INDIANAPOLIS, IN 46268-1536
(317) 762-0888
Mailing address
5455 W 86TH ST STE 102, INDIANAPOLIS, IN 46268-1536
(317) 762-0888
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001400A
IN
1041C0700X
Clinical Social Worker
Primary
34004283A
IN
Other
Enumeration date
08/20/2015
Last updated
07/22/2016
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