Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033258801 |
---|---|
Provider Name | Mrs. Lydia Ann Banks I |
First Address | Los Angeles, CA 90018-2309 |
Second Address | Los Angeles, CA 90062-1105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 26/11/2019 |