Provider Demographics
NPI:1497369078
Name:NETTELHORST KNIGHT, VANESSA RACHAEL (MA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RACHAEL
Last Name:NETTELHORST KNIGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:RACHAEL
Other - Last Name:NETTELHORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45116 CAMOLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2048
Mailing Address - Country:US
Mailing Address - Phone:818-626-4037
Mailing Address - Fax:
Practice Address - Street 1:7120 N MARKS AVE UNIT 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0268
Practice Address - Country:US
Practice Address - Phone:559-439-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CAAMFT132443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program