Individual
DR. ETHAN SCOTT BANNAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
271 FT RICHARDSON AVE, GOODFELLOW AFB, TX 76908
(325) 654-3122
(325) 654-5161
Mailing address
271 FT RICHARDSON AVE, GOODFELLOW AIR FORCE BASE, TX 76908
(325) 654-3122
(325) 654-5161
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
0810007978
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/10/2017
Last updated
07/13/2023
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