Provider Demographics
NPI:1942765839
Name:BANKS, BRENDA L (LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:BANKS
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E HARWOOD RD APT 1136
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3024
Mailing Address - Country:US
Mailing Address - Phone:214-598-0884
Mailing Address - Fax:
Practice Address - Street 1:425 E HARWOOD RD APT 1136
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-3024
Practice Address - Country:US
Practice Address - Phone:214-598-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11143101YA0400X
TX79648101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)