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Individual

MR. KEITH BANTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
3430 NEWBURG RD, SUITE 212, LOUISVILLE, KY 40218-2497
(502) 454-8800
(502) 736-0140
Mailing address
3430 NEWBURG RD, SUITE 212, LOUISVILLE, KY 40218-2497
(502) 454-8800
(502) 736-0140

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1194
KY

Other

Enumeration date
01/24/2007
Last updated
07/08/2007
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