Healthcare Provider Details

I. General information

NPI: 1508466939
Provider Name (Legal Business Name): LAURA PATRICE BANKS STARKS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 SOM CENTER RD 201
CLEVELAND OH
44124
US

IV. Provider business mailing address

1438 SOM CENTER RD NO 201
MAYFIELD HEIGHTS OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 216-688-5110
  • Fax:
Mailing address:
  • Phone: 216-688-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1126119
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95175418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: