Provider Demographics
NPI:1376059915
Name:KNOX, ERASMUS JOHN
Entity Type:Individual
Prefix:
First Name:ERASMUS
Middle Name:JOHN
Last Name:KNOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14757 COHASSET ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1802
Mailing Address - Country:US
Mailing Address - Phone:818-826-1999
Mailing Address - Fax:
Practice Address - Street 1:14757 COHASSET STREET
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1802
Practice Address - Country:US
Practice Address - Phone:818-826-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1281521017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1281521017OtherCCAPP