MARK CODY BANTA

OKLAHOMA CITY, OK
NPI1013138965
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2007-05-01
Last Update Date2009-09-01
Business Address
Mr. MARK CODY BANTA LPC u/s, CADC
3033 N WALNUT AVE
OKLAHOMA CITY, OK 73105-2832
Phone number: 405-230-1145
Mailing Address
Mr. MARK CODY BANTA LPC u/s, CADC
1216 MOCKINGBIRD LN
EDMOND, OK 73034-5788
Phone number: 405-285-7605
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