Provider Demographics
NPI:1790775500
Name:KNIGHT, TIMOTHY L (HSPP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-0769
Mailing Address - Country:US
Mailing Address - Phone:812-482-3020
Mailing Address - Fax:812-482-6409
Practice Address - Street 1:488 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-8807
Practice Address - Country:US
Practice Address - Phone:812-482-3020
Practice Address - Fax:812-482-6409
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040288A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN212570BMedicare ID - Type Unspecified