Julia Lynn Banta, LCPC

Key facts

NPI

1801001789

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

Practice address

203 N Wabash Ave
Suite 2106
Chicago, IL 60601-2406

Phone

(312) 551-9300

NPI assigned

May 13, 2007

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801001789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 N PAULINA ST",
            "address_2": "#103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221495",
            "telephone_number": "773-384-7093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 N WABASH AVE",
            "address_2": "SUITE 2106",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606012406",
            "telephone_number": "312-551-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANTA",
        "first_name": "JULIA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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