MEDICARE: TANYA BANKSTON LLPC

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	101YP2500X	Professional Counselor	6401018086	MI

General Provider Information

NPI Number	:	1972134591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA BANKSTON LLPC

Provider Business Mailing Address
First Line	:	22430 GRATIOT AVE UNIT 620
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-7022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 MORAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-1705
Country	:	US
Telephone Number	:	313-402-2062
Fax Number	:

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

Provider Enumeration Date	:	02/01/2020
Last Update Date	:	02/01/2020

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