Healthcare Provider Details

I. General information

NPI: 1972764611
Provider Name (Legal Business Name): MARCUS ANDREW BANKS-BEY SR. M.DIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 11/27/2022
Certification Date: 11/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W MAIN ST
MERCED CA
95340-4521
US

IV. Provider business mailing address

1020 W MAIN ST
MERCED CA
95340-4521
US

V. Phone/Fax

Practice location:
  • Phone: 209-330-7155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: