Christopher Joseph Banta, BA PSYCHOLOGY
Individual provider Active NPI Rehabilitation Psychologist · Rexburg, ID
NPI 1164545877 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164545877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rehabilitation Psychologist 103TR0400X
- Practice address
- 218 Dividend Dr Ste 3
Rexburg, ID 83440-3510 - Phone
- (208) 359-9683
- NPI assigned
- Apr 9, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ostermiller Counseling Services Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | Yes |
Addresses
Primary practice location
218 Dividend Dr Ste 3
Rexburg, ID 83440-3510
Mailing address
635 Angela Dr
Rexburg, ID 83440-1422
Phone (208) 351-0149
Other providers in Rexburg, ID
- Kendra Lyn Bagshaw
- Jorie Bailey
- Ashleigh Ball
- Brittney Ball
- Brianne R Banks
- Laura Anne Barcelo
- William David Barker
- Liam Barnard
- Jessica Christine Barnes
- Shayna Barnhill
All providers in Rexburg, ID · Rehabilitation Psychologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.