MEDICARE: MISS KATHERINE ELIZABETH KNOX MA LLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401007817	MI

General Provider Information

NPI Number	:	1003875576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHERINE ELIZABETH KNOX MA LLPC

Provider Business Mailing Address
First Line	:	1219 MINNESOTA ROAD
Second Line	:	#138
City	:	PORT HURON
State	:	MI
Zip	:	48060
Country	:	US
Telephone Number	:	810-388-1181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 NORTH RIVER RAOD
Second Line	:	NORSERV GROUP
City	:	ST CLAIR
State	:	MI
Zip	:	48079
Country	:	US
Telephone Number	:	810-329-4798
Fax Number	:	810-329-7303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/08/2007

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