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General NPI Number Information
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NPI Number | 1134361546
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Entity Type | Organization
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Legal Business Name | ELIZABETH E KNOWLES, PH.D., PA
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 4241 N GABEL DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5004
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Country | US
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Telephone | 479-444-8989
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Fax | 479-444-7545
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Provider Business Mailing Address
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Address Line | 1231 E SOUTHERN HEIGHTS PL
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-1309
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Country | US
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Telephone | 479-521-6104
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Fax | 479-575-7545
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIZABETH E KNOWLES
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Credential | PH.D.
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Telephone | 479-521-6104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | AR 89-20P
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License Number State | AR
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