Individual
ELISABETH LOUISE BROCKMAN-KNIGHT
Active
Individual
ELISABETH LOUISE BROCKMAN-KNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2005025848
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538204904
FACILITY NPI
MO
01
—
1649269622
BILLING NPI NUMBER
MO
01
—
2005025848
STATE LICENCE
MO
01
—
431004805
FACILITY TAX ID
MO
01
—
506201904
HCY MEDICAID NUMBER
MO
Enumeration date
06/04/2007
Last updated
10/09/2018
Update your record
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