Provider Demographics
NPI:1831677517
Name:BANKS-WILSON, KRISTA ELYSE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ELYSE
Last Name:BANKS-WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3321 N BUFFALO DR # 225
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6678
Mailing Address - Country:US
Mailing Address - Phone:702-857-8800
Mailing Address - Fax:702-857-8801
Practice Address - Street 1:3035 S MARYLAND PKWY # 109
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2200
Practice Address - Country:US
Practice Address - Phone:702-857-8800
Practice Address - Fax:702-857-8801
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11557-C1041C0700X
IN34008096A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical