Provider Demographics
NPI:1104212257
Name:KNOX, STACY (AMFT120724)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:KNOX
Suffix:
Gender:F
Credentials:AMFT120724
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 STINE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4176
Mailing Address - Country:US
Mailing Address - Phone:661-396-2360
Mailing Address - Fax:661-396-2362
Practice Address - Street 1:4301 DE ETTE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2916
Practice Address - Country:US
Practice Address - Phone:661-827-9219
Practice Address - Fax:661-827-9221
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT120724106H00000X
CA6306-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)