Provider Demographics
NPI:1760040547
Name:BANKS, TARA (BSW)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2108
Mailing Address - Country:US
Mailing Address - Phone:601-437-5504
Mailing Address - Fax:601-437-5506
Practice Address - Street 1:306 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2108
Practice Address - Country:US
Practice Address - Phone:601-437-5504
Practice Address - Fax:601-437-5505
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker