Provider Demographics
NPI:1326572694
Name:BANKS, LOUIS
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LOUIS
Other - Middle Name:BARRY
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1701 WHITE STREET
Mailing Address - Street 2:PO BOX 768
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648
Mailing Address - Country:US
Mailing Address - Phone:601-249-4218
Mailing Address - Fax:601-249-4234
Practice Address - Street 1:1701 WHITE STREET
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-249-4218
Practice Address - Fax:601-249-4234
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)