Basic Information
| Provider Information | |||||||||
| NPI: | 1285769471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANKS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | LPC, LMFT, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MARYWOOD CT | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701282030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049147997 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2121 RIDGELAKE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700012080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 08/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2247 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 642 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.