Provider Demographics
NPI:1346519931
Name:KNOWLES, MADISON (MS, LMHC, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MS, LMHC, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 E 800 N
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-5356
Mailing Address - Country:US
Mailing Address - Phone:732-606-6984
Mailing Address - Fax:
Practice Address - Street 1:1170 E 800 N
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-5356
Practice Address - Country:US
Practice Address - Phone:772-284-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019934101YM0800X
WI10663-125101YM0800X
FLMH22655101YM0800X, 101YM0800X
103K00000X, 247200000X
IDLCPC-9941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other