Organization
MBKNOWLES BEHAVIOR & MENTAL HEALTH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADISON KNOWLES LCPC (LICENSED COUNSELOR)
(732) 606-6984
Entity
Organization
Contact information
Practice address
1170 E 800 N, SHELLEY, ID 83274-5356
(772) 284-1873
Mailing address
1170 E 800 N, SHELLEY, ID 83274-5356
(772) 284-1873
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
102L00000X
Psychoanalyst
—
—
103K00000X
Behavior Analyst
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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