Healthcare Provider Details

I. General information

NPI: 1881562742
Provider Name (Legal Business Name): STEVEN JOHN KNIFFEN SUDRC LL, CMPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E 4TH ST
LONG BEACH CA
90802-1800
US

IV. Provider business mailing address

1124 DAWSON AVE. #2
LONG BEACH CA
90804
US

V. Phone/Fax

Practice location:
  • Phone: 562-453-5157
  • Fax:
Mailing address:
  • Phone: 562-721-8298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1594160125
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-HSZTOD
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: