Provider Demographics
NPI:1497979447
Name:KNAUTS, STEVEN KYLE (PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KYLE
Last Name:KNAUTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 N MARIETTA PKWY NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1529
Mailing Address - Country:US
Mailing Address - Phone:770-919-9088
Mailing Address - Fax:770-919-8708
Practice Address - Street 1:698 N MARIETTA PKWY NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1529
Practice Address - Country:US
Practice Address - Phone:770-919-9088
Practice Address - Fax:770-919-8708
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002846103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical