Provider Demographics
NPI:1336461110
Name:BANKS, BRIGETTE LATRICE (MS)
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:LATRICE
Last Name:BANKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10408 E 57TH TER
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3302
Mailing Address - Country:US
Mailing Address - Phone:816-420-7092
Mailing Address - Fax:
Practice Address - Street 1:421 E 137TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1455
Practice Address - Country:US
Practice Address - Phone:816-508-3709
Practice Address - Fax:816-508-3797
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009038601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional