Healthcare Provider Details

I. General information

NPI: 1023897550
Provider Name (Legal Business Name): ALIX PATRICK BANKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 UPPERLINE ST
NEW ORLEANS LA
70115-6937
US

IV. Provider business mailing address

2916 UPPERLINE ST
NEW ORLEANS LA
70115-6937
US

V. Phone/Fax

Practice location:
  • Phone: 504-621-3420
  • Fax:
Mailing address:
  • Phone: 504-621-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number8514
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: