Healthcare Provider Details

I. General information

NPI: 1366841108
Provider Name (Legal Business Name): BRIAN KNAPP MFT-INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 RENAISSANCE DR STE C
LAS VEGAS NV
89119-6751
US

IV. Provider business mailing address

2255 RENAISSANCE DR STE C
LAS VEGAS NV
89119-6751
US

V. Phone/Fax

Practice location:
  • Phone: 702-901-4880
  • Fax:
Mailing address:
  • Phone: 702-901-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02298-I
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCI0920
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: