Banks, Glenn L

Banks, Glenn L is an individual health care provider with primary practice located at 18444 N 25Th Ave Ste 210 , Phoenix AZ 85023-1264. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Banks, Glenn L can be contacted via phone (666) 974-2673.

Contact Information

Primary practice address
18444 N 25Th Ave Ste 210 Phoenix AZ 85023-1264
Phone: (666) 974-2673
Fax: (866) 939-2673
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 10525 Arizona
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X LISAC-10525 Arizona

Profile Details

NPI number 1053580381
LBN Legal business name Banks, Glenn L
Credentials MFCT, LISAC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2008
Last updated Sep 6th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053580381 NPPES
Arizona MEDICAID 250003

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