Healthcare Provider Details

I. General information

NPI: 1104344951
Provider Name (Legal Business Name): MATTHEW ALAN KNABE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MULL AVE
AKRON OH
44313
US

IV. Provider business mailing address

4278 BUNKER LN
STOW OH
44224-2819
US

V. Phone/Fax

Practice location:
  • Phone: 800-621-5207
  • Fax:
Mailing address:
  • Phone: 615-579-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1700632
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: