Healthcare Provider Details

I. General information

NPI: 1336461110
Provider Name (Legal Business Name): BRIGETTE LATRICE BANKS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E 137TH ST
KANSAS CITY MO
64145-1455
US

IV. Provider business mailing address

10408 E 57TH TER
RAYTOWN MO
64133-3302
US

V. Phone/Fax

Practice location:
  • Phone: 816-508-3709
  • Fax: 816-508-3797
Mailing address:
  • Phone: 816-420-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2009038601
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: