Provider Demographics
NPI:1689021669
Name:MCKNIGHT, BETHANY A (LMLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1944
Mailing Address - Country:US
Mailing Address - Phone:913-379-1394
Mailing Address - Fax:
Practice Address - Street 1:7501 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1944
Practice Address - Country:US
Practice Address - Phone:913-370-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical