Provider Demographics
NPI:1598443293
Name:MCKNIGHT, KATY M (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:M
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MAE
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12175 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-7780
Mailing Address - Country:US
Mailing Address - Phone:573-578-3261
Mailing Address - Fax:
Practice Address - Street 1:1202 HOMELIFE PLZ
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2512
Practice Address - Country:US
Practice Address - Phone:573-308-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023024664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional