MEDICARE: BANKS CENTER FOR INSIGHT, COUNSELING AND HEALTH RESOURCES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	6801094417	MI

General Provider Information

NPI Number	:	1992196281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANKS CENTER FOR INSIGHT, COUNSELING AND HEALTH RESOURCES

Provider Business Mailing Address
First Line	:	2328 E 7 MILE RD
Second Line	:	STE. 4
City	:	DETROIT
State	:	MI
Zip	:	48234-1304
Country	:	US
Telephone Number	:	313-305-4008
Fax Number	:	313-305-4972

Provider Business Practice Location Address
First Line	:	2328 E 7 MILE RD
Second Line	:	STE. 4
City	:	DETROIT
State	:	MI
Zip	:	48234-1304
Country	:	US
Telephone Number	:	313-305-4008
Fax Number	:	313-305-4972

Authorized Official
Title or Position	:	PSYCHOTHERAPY
Name	:	EUNICE CAROLYN BANKS
Credential	:	LCSW
Telephone Number	:	313-305-4008

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	03/24/2015

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