Provider Demographics
NPI:1912210311
Name:KNIGHT, JEANICE MARIE (PLMHP, MS)
Entity Type:Individual
Prefix:
First Name:JEANICE
Middle Name:MARIE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PLMHP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 HIDDEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2737
Mailing Address - Country:US
Mailing Address - Phone:402-677-9083
Mailing Address - Fax:712-307-6015
Practice Address - Street 1:118 N ELM ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:IA
Practice Address - Zip Code:51521-3510
Practice Address - Country:US
Practice Address - Phone:402-677-9083
Practice Address - Fax:712-307-6015
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health