Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 10953 | FL |
NPI | 1033622147 |
---|---|
Provider Name | Dr. Krystal L. Banks |
First Address | Wasilla, AK 99654-8067 |
Second Address | Wasilla, AK 99654-8067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2017 |
Last Update Date | 10/10/2019 |