Provider Demographics
NPI:1659786598
Name:HANKS, JUDY
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:HANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 WILDER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-3838
Mailing Address - Country:US
Mailing Address - Phone:214-710-5702
Mailing Address - Fax:
Practice Address - Street 1:3810 WILDER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-3838
Practice Address - Country:US
Practice Address - Phone:214-710-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information