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1679163315 NPI number — BRANDON WAYNE BANKS LPC

NPI Number: 1679163315
Health Care Provider/Practitioner: BRANDON WAYNE BANKS LPC

Information about “1679163315” NPI (BRANDON WAYNE BANKS LPC) exists in 1679163315 in HTML format HTML  |  1679163315 in plain Text format TXT  |  1679163315 in PDF (Portable Document Format) PDF  |  1679163315 in an XML format XML  formats.

NPI Number : 1679163315 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679163315",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BANKS",
    "FirstName": "BRANDON",
    "MiddleName": "WAYNE",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1415 OLD WEISGARBER RD STE 360",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KNOXVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37909-1381",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "865-588-3173",
    "MailingAddressFaxNumber": "865-588-3174",
    "FirstLinePracticeLocationAddress": "1415 OLD WEISGARBER RD STE 360",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KNOXVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37909-1381",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "865-588-3173",
    "PracticeLocationAddressFaxNumber": "865-588-3174",
    "EnumerationDate": "01/26/2021",
    "LastUpdateDate": "01/08/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "04/01/2021",
    "NPIReactivationDate": "05/25/2021",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "5562",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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