Holly Annette Bankston, LPC & LCDC

Key facts

NPI

1841978749

Entity type

Individual (NPI type 1)

Primary specialty

Professional Counselor 101YP2500X

License

71584 (TX)

Practice address

4204 S Meridian Greens Dr
Dickinson, TX 77539-8367

Phone

(409) 739-8471

NPI assigned

Jul 10, 2023

Sex

Female

Sole proprietor

No

Medicare Care Compare profile

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

Other names

• Holly Annette Shead Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 10, 2023.

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1841978749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4204 S MERIDIAN GREENS DR",
            "city": "DICKINSON",
            "state": "TX",
            "postal_code": "775398367",
            "telephone_number": "409-739-8471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 S MERIDIAN GREENS DR",
            "city": "DICKINSON",
            "state": "TX",
            "postal_code": "775398367",
            "telephone_number": "409-739-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANKSTON",
        "first_name": "HOLLY",
        "middle_name": "ANNETTE",
        "credential": "LPC  & LCDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "12793",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "71584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "SHEAD",
            "middle_name": "ANNETTE",
            "credential": "LPC & LCDC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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