=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417681982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHOLISTIC PSYCHIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2022
-----------------------------------------------------
Last Update Date | 07/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2929 W 31ST ST APT 10L4
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11224-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-536-6212
-----------------------------------------------------
Fax | 917-508-4842
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 MISSOURI RD
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34293-6447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-536-6212
-----------------------------------------------------
Fax | 917-508-4842
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CLINICIAN
-----------------------------------------------------
Name | DR. MICHELLE MARIE KNAPP
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 216-536-6212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------