Provider Demographics
NPI:1558825828
Name:KNIGHT, DUSTIN ROBERT (MS)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ROBERT
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2997
Mailing Address - Country:US
Mailing Address - Phone:818-788-2388
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 403
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2997
Practice Address - Country:US
Practice Address - Phone:818-788-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst