Provider Demographics
NPI:1922609130
Name:BANKS, TRE'LUN ROMOND
Entity Type:Individual
Prefix:
First Name:TRE'LUN
Middle Name:ROMOND
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 1:16110 KIRSTEN DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4270
Mailing Address - Country:US
Mailing Address - Phone:318-655-7243
Mailing Address - Fax:
Practice Address - Street 1:9410 LINDALE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4160
Practice Address - Country:US
Practice Address - Phone:225-768-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator