Provider Demographics
NPI:1396818894
Name:BANKS, MAUREEN ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:BANKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 W BUSCH BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4545
Mailing Address - Country:US
Mailing Address - Phone:813-931-5933
Mailing Address - Fax:813-931-3974
Practice Address - Street 1:2529 W BUSCH BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4545
Practice Address - Country:US
Practice Address - Phone:813-931-5933
Practice Address - Fax:813-931-3974
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 987101YA0400X
FLMH0003760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)