Healthcare Provider Details

I. General information

NPI: 1679739700
Provider Name (Legal Business Name): RICHARD KNEIP, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346
US

IV. Provider business mailing address

PO BOX 772263
DETROIT MI
48277-2263
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax: 248-605-3525
Mailing address:
  • Phone: 800-693-1916
  • Fax: 248-605-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6301007060
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD CARL KNEIP
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 248-701-2017