Healthcare Provider Details

I. General information

NPI: 1326653072
Provider Name (Legal Business Name): MIKEA C KNOX MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 HULEN ST
FORT WORTH TX
76107-7277
US

IV. Provider business mailing address

PO BOX 2603
FORT WORTH TX
76113-2603
US

V. Phone/Fax

Practice location:
  • Phone: 178-335-3022
  • Fax:
Mailing address:
  • Phone: 178-569-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88207
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: