Provider Information for 1689091225
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MANDY KNIGHT LCSW
Sex: Female
NPI: 1689091225
Last Updated: 2020-02-18
Certification Date: 2020-02-18
Certification Date: 2020-02-18
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1689091225 | ||||||||||||
| Enumeration Date | 2014-03-20 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 1217 EL RENO, OK 73036-1217 United States Phone: 405-919-5807 | Fax: | ||||||||||||
| Primary Practice Address | 600 S. CHOCTAW AVE EL RENO, OK 73036-7303 United States Phone: 405-919-5807 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 6051 N BROOKLINE AVE | ||||||||||||
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