Active NPI
Ethan Scott Bannar, PSYD
- Clinical Psychologist
- Goodfellow Afb, TX
National Provider Identifier
1467962928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810007978
- Practice address
- 271 Ft Richardson Ave
Goodfellow Afb, TX 76908 - Phone
- (325) 654-3122
- Fax
- (325) 654-5161
- NPI assigned
- Oct 10, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | 0810007978 | VA | Primary |
Addresses
Primary practice location
271 Ft Richardson Ave
Goodfellow Afb, TX 76908
Mailing address
271 Ft Richardson Ave
Goodfellow Air Force Base, TX 76908
Phone (325) 654-3122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810007978 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689206400000",
"number": "1467962928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "271 FT RICHARDSON AVE",
"city": "GOODFELLOW AIR FORCE BASE",
"state": "TX",
"postal_code": "76908",
"telephone_number": "325-654-3122",
"fax_number": "325-654-5161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "271 FT RICHARDSON AVE",
"city": "GOODFELLOW AFB",
"state": "TX",
"postal_code": "76908",
"telephone_number": "325-654-3122",
"fax_number": "325-654-5161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNAR",
"first_name": "ETHAN",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-10",
"last_updated": "2023-07-13",
"certification_date": "2023-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810007978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodfellow Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.