Provider Demographics
NPI:1437524204
Name:BANNAN, DEBORAH (LPC-S)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BANNAN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MANGUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 KEENAN DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3706
Mailing Address - Country:US
Mailing Address - Phone:907-885-5955
Mailing Address - Fax:
Practice Address - Street 1:2817 KEENAN DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3706
Practice Address - Country:US
Practice Address - Phone:907-885-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional