Healthcare Provider Details

I. General information

NPI: 1215208665
Provider Name (Legal Business Name): HENRIETTA WILHELMINA KNOX MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HENRIETTE WILHELMINA KNOX-DE KNIJFF MA, LPC

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 WASHINGTON ST
EUGENE OR
97401-4606
US

IV. Provider business mailing address

2440 WILLAMETTE ST STE 201
EUGENE OR
97405-3170
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-2278
  • Fax:
Mailing address:
  • Phone: 541-321-2278
  • Fax: 541-246-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2778
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500682607
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: