Provider Demographics
NPI:1174241467
Name:BANKS, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 MOUNTAIN VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24590-3818
Mailing Address - Country:US
Mailing Address - Phone:434-987-3358
Mailing Address - Fax:
Practice Address - Street 1:2100 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5703
Practice Address - Country:US
Practice Address - Phone:703-228-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health