Healthcare Provider Details

I. General information

NPI: 1255711057
Provider Name (Legal Business Name): COURTNEY MARIE BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SANTA FE AVE
COMPTON CA
90221-3814
US

IV. Provider business mailing address

501 S SANTA FE AVE
COMPTON CA
90221-3814
US

V. Phone/Fax

Practice location:
  • Phone: 559-816-7035
  • Fax:
Mailing address:
  • Phone: 559-816-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number210087187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: