MEDICARE: MITTIE KNOX

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	1041C0700X	Clinical Social Worker	36731	TX

General Provider Information

NPI Number	:	1972375525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITTIE KNOX

Provider Business Mailing Address
First Line	:	9901 BRODIE LN
Second Line	:	SUITE 160 PMB793
City	:	AUSTIN
State	:	TX
Zip	:	78748
Country	:	US
Telephone Number	:	512-380-1636
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 MANOR RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-5522
Country	:	US
Telephone Number	:	512-380-1636
Fax Number	:

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

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	10/26/2023

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Directions to “ MITTIE KNOX ” Practice Location

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