| Doctor Name: | KELLY BANKS |
| NPI Number: | 1033406269 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MHP |
| License Number: | |
| Business Practice Address: | 101 S Locust St Centralia, IL - 628013506 |
| Business Phone Number: | 6185331391 |
| Business Fax Number: | |
| Mailing Address: | Po Box 201, SALEM |
| State: | IL |
| Postal Code: | 628810201 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/08/2011 |
| NPI Last Update Date: | 07/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |