Provider Demographics
NPI:1578993457
Name:KNOTT, BRETT JR (LICDC-CS, LPC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:KNOTT
Suffix:JR
Gender:M
Credentials:LICDC-CS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 GRASS RUN
Mailing Address - Street 2:
Mailing Address - City:NEW MARSHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45766-9727
Mailing Address - Country:US
Mailing Address - Phone:740-517-9272
Mailing Address - Fax:
Practice Address - Street 1:12888 GREY ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9638
Practice Address - Country:US
Practice Address - Phone:740-517-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111-060-CS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200008Medicaid