Provider Demographics
NPI:1689004228
Name:KNOWLES, MANDY
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 S CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4418
Mailing Address - Country:US
Mailing Address - Phone:559-730-2969
Mailing Address - Fax:559-730-2991
Practice Address - Street 1:28050 ROAD 148
Practice Address - Street 2:ROOM 20
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-9297
Practice Address - Country:US
Practice Address - Phone:559-747-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health