MEDICARE: AMY KNIZEK COUNSELING, PLLC

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	251S00000X	Community/Behavioral Health Agency	LH60160750	WA

General Provider Information

NPI Number	:	1962718858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY KNIZEK COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 10013
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99209-1013
Country	:	US
Telephone Number	:	509-570-4804
Fax Number	:	509-242-3002

Provider Business Practice Location Address
First Line	:	1212 N WASHINGTON ST
Second Line	:	ONE ROCK POINTE, STE 306
City	:	SPOKANE
State	:	WA
Zip	:	99201-2403
Country	:	US
Telephone Number	:	509-570-4804
Fax Number	:	509-242-3002

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	AMY KNIZEK
Credential	:	M.ED, LMHC, CRC
Telephone Number	:	509-570-4804

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	12/19/2011

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