Provider Demographics
NPI:1932505328
Name:BANKS, JEREMY (CLINICIAN I)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BANKS
Suffix:
Gender:M
Credentials:CLINICIAN I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:602-599-5404
Mailing Address - Fax:602-599-5704
Practice Address - Street 1:235 E RAY RD
Practice Address - Street 2:APT 1083
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3344
Practice Address - Country:US
Practice Address - Phone:602-599-5575
Practice Address - Fax:602-599-5875
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator