Provider Demographics
NPI:1154730422
Name:BANKS, TAMMIKA
Entity type:Individual
Prefix:
First Name:TAMMIKA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 E MICA RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5639
Mailing Address - Country:US
Mailing Address - Phone:602-312-9816
Mailing Address - Fax:
Practice Address - Street 1:4103 E MICA RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5639
Practice Address - Country:US
Practice Address - Phone:602-312-9816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171W00000XOther Service ProvidersContractor