Individual
ELISABETH LOUISE BROCKMAN-KNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1000 W NIFONG BLVD, COLUMBIA, MO 65203-5615
(888) 403-1071
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
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
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