MEDICARE: MS. ROBIN KNOX MFT INTERN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61466	OTHER	CA	AC BHCS CLINICIAN #

General Provider Information

NPI Number	:	1104021005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBIN KNOX MFT INTERN

Provider Business Mailing Address
First Line	:	2921 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1409
Country	:	US
Telephone Number	:	702-942-1774
Fax Number	:	702-942-1773

Provider Business Practice Location Address
First Line	:	2921 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1409
Country	:	US
Telephone Number	:	702-942-1774
Fax Number	:	702-942-1773

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	09/15/2021

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