Provider Demographics
NPI:1477754034
Name:BANKS, BOB (APPS COUNSELOR)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:APPS COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6601
Mailing Address - Country:US
Mailing Address - Phone:620-231-5130
Mailing Address - Fax:
Practice Address - Street 1:810 CEDAR ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2056
Practice Address - Country:US
Practice Address - Phone:620-724-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)