Provider Demographics
NPI:1518723022
Name:BANKS, KURTIS P
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:P
Last Name:BANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-9111
Mailing Address - Country:US
Mailing Address - Phone:810-705-1452
Mailing Address - Fax:
Practice Address - Street 1:8032 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-9719
Practice Address - Country:US
Practice Address - Phone:810-201-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician