Healthcare Provider Details

I. General information

NPI: 1336746577
Provider Name (Legal Business Name): CASEY KNIGHT NLC, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E 42ND ST
LOVELAND CO
80538-2351
US

IV. Provider business mailing address

119 E 42ND ST
LOVELAND CO
80538-2351
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-9068
  • Fax:
Mailing address:
  • Phone: 970-310-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: