Provider Demographics
NPI:1295355071
Name:BANKS, CATHY SHELTON (DD, THEOLOGY)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:SHELTON
Last Name:BANKS
Suffix:
Gender:F
Credentials:DD, THEOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PAR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5925
Mailing Address - Country:US
Mailing Address - Phone:337-263-5448
Mailing Address - Fax:337-263-5448
Practice Address - Street 1:1639 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5948
Practice Address - Country:US
Practice Address - Phone:337-721-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty