Individual
THOMAS PATRICK BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAC
Contact information
Practice address
1220 MISSOURI AVE, JEFFERSONVILLE, IN 47130-3725
(812) 283-2217
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001744A
IN
101YM0800X
Mental Health Counselor
88001398A
IN
Other
Enumeration date
07/08/2024
Last updated
10/07/2025
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