Mr. MARK CODY BANTA LPC
Individual Provider (NPI-1)
Active
Counselor, Mental Health
Provider Information
- NPI Number
1013138965- Provider Type
- Individual Provider (NPI-1)
- Credentials
- LPC
- Status
- Active
Contact & Location
- Address
- 105365 S.HWY 102, MCLOUD, OK, 74851
- Phone
- (405) 988-2618
Specialties & Taxonomies
Counselor, Mental Health
Primary License: OK #04525