Basic Information
| Provider Information | |||||||||
| NPI: | 1922610898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANKS | ||||||||
| FirstName: | ALYSSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 457 NORA DR | ||||||||
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| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435511475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193277383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 N ERIE ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192419277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2020 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.