Active NPI
Mary Gaye Banas, LPC-INTERN
- Professional Counselor
- Colleyville, TX
National Provider Identifier
1063031607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 83802
- Practice address
- 8090 Precinct Line Rd Ste 103
Colleyville, TX 76034-7677 - Phone
- (469) 667-4096
- NPI assigned
- Apr 14, 2020
- Last updated
- Dec 10, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 83802 | TX | Primary |
Addresses
Primary practice location
8090 Precinct Line Rd Ste 103
Colleyville, TX 76034-7677
Mailing address
8090 Precinct Line Rd Ste 103
Colleyville, TX 76034-7677
Phone (469) 667-4096
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 19, 2024 through Feb 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83802 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733788800000",
"number": "1063031607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8090 PRECINCT LINE RD STE 103",
"city": "COLLEYVILLE",
"state": "TX",
"postal_code": "760347677",
"telephone_number": "469-667-4096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8090 PRECINCT LINE RD STE 103",
"city": "COLLEYVILLE",
"state": "TX",
"postal_code": "760347677",
"telephone_number": "469-667-4096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANAS",
"first_name": "MARY",
"middle_name": "GAYE",
"credential": "LPC-INTERN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-14",
"last_updated": "2024-12-10",
"certification_date": "2024-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "83802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colleyville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.