MEDICARE: AMELIA NICOLE BANKS M.A.,BCBA,PCPL

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	101YS0200X	School Counselor	AN536284	LA
2	101YP2500X	Professional Counselor	CI-5806	LA
3	103K00000X	Behavior Analyst	L-135	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447671029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA NICOLE BANKS M.A.,BCBA,PCPL

Provider Business Mailing Address
First Line	:	806 W FIVE MILE PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-4913
Country	:	US
Telephone Number	:	318-805-4115
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 W FIVE MILE PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-4913
Country	:	US
Telephone Number	:	214-585-5995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2013
Last Update Date	:	04/29/2026

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