Provider Demographics
NPI:1679513568
Name:KNOWLES, JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KNOWLES
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 1:20004 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1596
Mailing Address - Country:US
Mailing Address - Phone:734-347-8002
Mailing Address - Fax:248-991-9360
Practice Address - Street 1:6588 SECOR RD STE A
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9499
Practice Address - Country:US
Practice Address - Phone:734-347-8002
Practice Address - Fax:248-991-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
04558OtherPARAMOUNT
MI680E812230OtherBCBS
MI680E812230OtherBCBS