Provider Demographics
NPI:1245291970
Name:BANKS, KRAMEELAH MARSHAE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRAMEELAH
Middle Name:MARSHAE
Last Name:BANKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 PLEASANT RIDGE RD
Mailing Address - Street 2:#345
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-2392
Mailing Address - Country:US
Mailing Address - Phone:501-960-5779
Mailing Address - Fax:501-219-9926
Practice Address - Street 1:1501 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5242
Practice Address - Country:US
Practice Address - Phone:501-960-5779
Practice Address - Fax:501-296-9984
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR05-13P103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y322OtherBXBS
AR156758719Medicaid