Provider Demographics
NPI:1962397109
Name:TUESDAY REIGN ORGANIZATION
Entity type:Organization
Organization Name:TUESDAY REIGN ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EZELL
Authorized Official - Middle Name:DANTE
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-774-8460
Mailing Address - Street 1:109 BROOKEFIELD AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4933
Mailing Address - Country:US
Mailing Address - Phone:972-774-8460
Mailing Address - Fax:
Practice Address - Street 1:5000 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8603
Practice Address - Country:US
Practice Address - Phone:972-774-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health