Provider Demographics
NPI:1477090413
Name:BANKS, EVELYNE (DMIN)
Entity Type:Individual
Prefix:
First Name:EVELYNE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W FOOTHILL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3786
Mailing Address - Country:US
Mailing Address - Phone:909-329-8238
Mailing Address - Fax:909-985-7193
Practice Address - Street 1:1126 W FOOTHILL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3786
Practice Address - Country:US
Practice Address - Phone:909-985-0513
Practice Address - Fax:909-985-7193
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health