Provider Demographics
NPI:1073670055
Name:KNAUSS, LARRY G (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:G
Last Name:KNAUSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23745 225TH WAY SE STE 201
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5294
Mailing Address - Country:US
Mailing Address - Phone:425-443-6471
Mailing Address - Fax:888-712-6449
Practice Address - Street 1:23745 225TH WAY SE STE 201
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5294
Practice Address - Country:US
Practice Address - Phone:425-443-6471
Practice Address - Fax:888-712-6449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003486103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist