MEDICARE: FELISA KNOWLES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor
2	106S00000X	Behavior Technician	OH
3	171M00000X	Case Manager/Care Coordinator
4	311ZA0620X	Adult Care Home Facility
5	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1245062298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELISA KNOWLES

Provider Business Mailing Address
First Line	:	2843 WASHINGTON BLVD STE 106
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2009
Country	:	US
Telephone Number	:	216-242-7725
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 WASHINGTON BLVD STE 106
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2009
Country	:	US
Telephone Number	:	216-242-7725
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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Directions to “ FELISA KNOWLES ” Practice Location

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