Provider Demographics
NPI:1033694757
Name:BANKSTON, BROOKE (BCBA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 QUAIL LNDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6222
Mailing Address - Country:US
Mailing Address - Phone:915-227-5554
Mailing Address - Fax:
Practice Address - Street 1:7115 QUAIL LNDG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6222
Practice Address - Country:US
Practice Address - Phone:915-227-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-18-32208103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst