Provider Information for 1831353911
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LYDIA RUTH BANTON LMHC
Sex: Female
NPI: 1831353911
Last Updated: 2014-03-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1831353911 | ||||||||
| Enumeration Date | 2008-07-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6626 E 75TH STREET SUITE 500 INDIANAPOLIS, IN 46250-2890 United States Phone: 317-621-7561 | Fax:317-355-6096 | ||||||||
| Primary Practice Address | 5470 EAST 16TH STREET INDIANAPOLIS, IN 46218-4861 United States Phone: 317-355-5394 | Fax:317-351-7580 | ||||||||
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