Mr Glenn L Banks Jr, MFCT, LISAC is a
Psychologist - Addiction (substance Use Disorder) based in Phoenix, Arizona. Mr Glenn L Banks Jr is licensed to practice in Arizona (license number LISAC-10525) and his current practice location is
18444 N 25th Ave Ste 210, Phoenix, Arizona. He can be reached at his office (for appointments etc.) via phone at
(666) 974-2673.
NPI number for Mr Glenn L Banks Jr is 1053580381 and his current mailing address is 18444 N 25th Ave Ste 310, Phoenix, Arizona. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1053580381.
Healthcare Provider's Profile
| Full Name | Mr Glenn L Banks Jr |
|---|
| Gender | Male |
|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
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| Location | 18444 N 25th Ave Ste 210, Phoenix, Arizona |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1053580381
- Provider Enumeration Date: 02/20/2008
- Last Update Date: 09/06/2022
Medical Identifiers
Medical identifiers for Mr Glenn L Banks Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1053580381 | NPI | - | NPPES |
| 250003 | Medicaid | AZ | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 10525 (Arizona) | Secondary |
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | LISAC-10525 (Arizona) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Glenn L Banks Jr is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Glenn L Banks Jr, MFCT, LISAC
18444 N 25th Ave Ste 310,
Phoenix, AZ 85023-1266
Ph: (866) 974-2673 | Mr Glenn L Banks Jr, MFCT, LISAC
18444 N 25th Ave Ste 210,
Phoenix, AZ 85023-1264
Ph: (666) 974-2673 |
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