Individual
KANESHA SIMMONS BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 W TERRELL AVE, FT WORTH, TX 76104-3243
(817) 702-3100
Mailing address
7400 MERTON MINTER ST, SAN ANTONIO, TX 78229-4404
(210) 617-5300
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
17055
TX
103T00000X
Psychologist
38979
TX
Other
Enumeration date
08/02/2021
Last updated
07/28/2022
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