Healthcare Provider Details

I. General information

NPI: 1235954678
Provider Name (Legal Business Name): MICHAEL WILLIAM KNOPES CRM, PSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 SW MYERS PL
GRESHAM OR
97080-9569
US

IV. Provider business mailing address

8915 SW CENTER ST
TIGARD OR
97223-6307
US

V. Phone/Fax

Practice location:
  • Phone: 971-678-4179
  • Fax:
Mailing address:
  • Phone: 503-726-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: