Provider Demographics
NPI:1366841108
Name:KNAPP, BRIAN (MFT-INTERN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KNAPP
Suffix:
Gender:M
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 RENAISSANCE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6751
Mailing Address - Country:US
Mailing Address - Phone:702-901-4880
Mailing Address - Fax:
Practice Address - Street 1:2255 RENAISSANCE DR STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6751
Practice Address - Country:US
Practice Address - Phone:702-901-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02298-I101YA0400X
NVCI0920106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194383133Medicaid