Provider Demographics
NPI:1710918669
Name:MCKNIGHT, ALTON (LPC)
Entity Type:Individual
Prefix:MR
First Name:ALTON
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3022
Mailing Address - Country:US
Mailing Address - Phone:318-222-6226
Mailing Address - Fax:318-221-8526
Practice Address - Street 1:2520 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3022
Practice Address - Country:US
Practice Address - Phone:318-222-6226
Practice Address - Fax:318-221-8526
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA156101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
721232650001OtherHUMANA MILITARY
LAB0307OtherBLUE CROSS OF LA