Individual
MARYBETH BANACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
510 HARTBROOK DR STE 201, HARTLAND, WI 53029-1444
(262) 853-9084
Mailing address
510 HARTBROOK DRIVE, SUITE 201, HARTLAND, WI 53029
(262) 853-9084
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5687-125
WI
Other
Enumeration date
05/28/2015
Last updated
05/28/2015
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