Provider Demographics
NPI:1710758412
Name:BANKS, TAYLOR ROSE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ROSE
Last Name:BANKS
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 1:42 BIRCH PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43217-1068
Mailing Address - Country:US
Mailing Address - Phone:614-378-9707
Mailing Address - Fax:
Practice Address - Street 1:42 BIRCH PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43217-1068
Practice Address - Country:US
Practice Address - Phone:614-378-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor