Provider Demographics
NPI:1568672566
Name:KNERR, MICHAEL (MS IMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KNERR
Suffix:
Gender:M
Credentials:MS IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 MEMORIAL DR STE 100D
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-9005
Mailing Address - Country:US
Mailing Address - Phone:614-389-0747
Mailing Address - Fax:
Practice Address - Street 1:6135 MEMORIAL DR STE 100D
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-9005
Practice Address - Country:US
Practice Address - Phone:614-389-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.0600001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist