MEDICARE: RAEGAN M KNIGHT BHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1497473128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAEGAN M KNIGHT BHT

Provider Business Mailing Address
First Line	:	1717 W NORTHERN AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5400
Country	:	US
Telephone Number	:	602-254-9701
Fax Number	:	602-755-1544

Provider Business Practice Location Address
First Line	:	1717 W NORTHERN AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5400
Country	:	US
Telephone Number	:	602-254-9701
Fax Number	:	602-755-1544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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