Provider Demographics
NPI:1104839984
Name:MCKNIGHT, CHAD E (LCSW)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50814
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-0814
Mailing Address - Country:US
Mailing Address - Phone:719-799-8070
Mailing Address - Fax:719-752-7605
Practice Address - Street 1:10 BOULDER CRESCENT ST STE 101-G
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-799-8070
Practice Address - Fax:719-752-7605
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW09923451041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249322701OtherMEDICARE ID NUMBER