MEDICARE: MR. KENDRICK M. EBANKS LMSW

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	101YM0800X	Mental Health Counselor	6958	LA
2	171M00000X	Case Manager/Care Coordinator	6958	LA
3	104100000X	Social Worker	6958	LA

General Provider Information

NPI Number	:	1467885327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENDRICK M. EBANKS LMSW

Provider Business Mailing Address
First Line	:	637 SAINT FERDINAND ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-6152
Country	:	US
Telephone Number	:	225-955-9527
Fax Number	:

Provider Business Practice Location Address
First Line	:	637 SAINT FERDINAND ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-6152
Country	:	US
Telephone Number	:	225-955-9527
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	11/30/2022

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