Provider Demographics
NPI:1376127910
Name:STEPHANIE BANKS
Entity type:Organization
Organization Name:STEPHANIE BANKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC, NCC
Authorized Official - Phone:985-260-2068
Mailing Address - Street 1:2964 CAMELLIA DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4229
Mailing Address - Country:US
Mailing Address - Phone:985-260-2068
Mailing Address - Fax:985-317-0139
Practice Address - Street 1:2964 CAMELLIA DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4229
Practice Address - Country:US
Practice Address - Phone:985-260-2068
Practice Address - Fax:985-317-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health