MEDICARE: MRS. RENE ARLENE KNOLES M.ED, LMHC, SUDPT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO60702754	WA
2	101YM0800X	Mental Health Counselor	MC 60186320	WA
3	101YM0800X	Mental Health Counselor	LH60335668	WA

General Provider Information

NPI Number	:	1912163775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENE ARLENE KNOLES M.ED, LMHC, SUDPT

Provider Business Mailing Address
First Line	:	8212 S. MARCH POINT ROAD
Second Line	:
City	:	ANACORTES
State	:	WA
Zip	:	98221-8684
Country	:	US
Telephone Number	:	360-588-2800
Fax Number	:	360-588-2808

Provider Business Practice Location Address
First Line	:	8212 S. MARCH POINT ROAD
Second Line	:
City	:	ANACORTES
State	:	WA
Zip	:	98221-8684
Country	:	US
Telephone Number	:	360-588-2800
Fax Number	:	360-588-2808

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

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	08/22/2019

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