Provider Demographics
NPI:1942403118
Name:BANKS, KRISTY (SUDCC II)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:SUDCC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93275-0688
Mailing Address - Country:US
Mailing Address - Phone:559-688-7531
Mailing Address - Fax:559-688-3509
Practice Address - Street 1:793 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2205
Practice Address - Country:US
Practice Address - Phone:559-688-7531
Practice Address - Fax:559-688-7531
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0511080229101YA0400X
CA6410101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)