MEDICARE: CLINT BANKS BEHAVIORAL HEALTH CONSULTING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1215495882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINT BANKS BEHAVIORAL HEALTH CONSULTING PLLC

Provider Business Mailing Address
First Line	:	680 BOLLONS ISLAND ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-0965
Country	:	US
Telephone Number	:	702-682-6080
Fax Number	:

Provider Business Practice Location Address
First Line	:	8870 S MARYLAND PKWY STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4010
Country	:	US
Telephone Number	:	702-682-6080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CLINT EMERY BANKS
Credential	:	LCSW
Telephone Number	:	702-682-6080

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	03/03/2019

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