MEDICARE: MS. MARY KNIGHT LCSW

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	101Y00000X	Counselor	18783	TX
2	251B00000X	Case Management Agency	18783	TX

General Provider Information

NPI Number	:	1588984934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KNIGHT LCSW

Provider Business Mailing Address
First Line	:	431 W WINTERGREEN RD APT 6102
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2664
Country	:	US
Telephone Number	:	972-800-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 W WINTERGREEN RD APT 6102
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2664
Country	:	US
Telephone Number	:	972-800-7863
Fax Number	:

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	04/13/2026

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