Provider Demographics
NPI:1649616962
Name:BANISTER, AARON WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:WILLIAM
Last Name:BANISTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S WALNUT ST STE 221
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2993
Mailing Address - Country:US
Mailing Address - Phone:812-523-7852
Mailing Address - Fax:812-523-7853
Practice Address - Street 1:415 S WALNUT ST STE 221
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2993
Practice Address - Country:US
Practice Address - Phone:812-523-7852
Practice Address - Fax:812-523-7853
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042674A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling