Provider Demographics
NPI:1376041087
Name:DAVID M KNIGHT PSYD LLC
Entity Type:Organization
Organization Name:DAVID M KNIGHT PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MACGREGOR
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:618-698-6299
Mailing Address - Street 1:1477 SCHWARZ MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6710
Mailing Address - Country:US
Mailing Address - Phone:618-698-6299
Mailing Address - Fax:
Practice Address - Street 1:11166 TESSON FERRY RD STE 203
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6966
Practice Address - Country:US
Practice Address - Phone:314-849-2120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140253251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health