Healthcare Provider Details

I. General information

NPI: 1871229724
Provider Name (Legal Business Name): JAMYE RENEE BANKS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13377 LAKE POINT BLVD
VAN BUREN TWP MI
48111-2288
US

IV. Provider business mailing address

2035 HOGBACK RD STE 201
ANN ARBOR MI
48105-9488
US

V. Phone/Fax

Practice location:
  • Phone: 716-480-4152
  • Fax:
Mailing address:
  • Phone: 734-252-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301018430
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301018430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: