Individual
MR. GLENN L BANKS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MFCT, LISAC
Contact information
Practice address
18444 N 25TH AVE STE 210, PHOENIX, AZ 85023-1264
(666) 974-2673
(866) 939-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10525
AZ
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
LISAC-10525
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250003
—
AZ
Enumeration date
02/20/2008
Last updated
09/06/2022
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