Doctor Name: | DR. PHILLIP BRUCE KNIGHT |
NPI Number: | 1932439130 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 6401011695 |
Business Practice Address: | 109 Battle Aly Holly, MI - 484421675 |
Business Phone Number: | 2482458878 |
Business Fax Number: | |
Mailing Address: | 15500 Silver Pkwy, #305 FENTON |
State: | MI |
Postal Code: | 484303474 |
Phone Number: | 2482458878 |
Fax Number: | |
NPI Enumeration Date: | 01/11/2010 |
NPI Last Update Date: | 01/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401011695 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |