Healthcare Provider Details

I. General information

NPI: 1396659777
Provider Name (Legal Business Name): TAKYRA BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RISE CENTER FOR AUTISM, 1070 W. HOUGHTON LAKE DRIVE,
YPSILANTI MI
48651
US

IV. Provider business mailing address

1460 MARIA ST
FLINT MI
48507-5528
US

V. Phone/Fax

Practice location:
  • Phone: 810-962-6935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberB520785585270
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: