Provider Demographics
NPI:1013073675
Name:KNIGHT COUNSELING CLINIC, INC.
Entity Type:Organization
Organization Name:KNIGHT COUNSELING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LISW AND ACSW
Authorized Official - Phone:216-291-0681
Mailing Address - Street 1:4405 MONTAGANO BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3544
Mailing Address - Country:US
Mailing Address - Phone:216-291-0681
Mailing Address - Fax:216-291-0681
Practice Address - Street 1:25901 EMERY RD
Practice Address - Street 2:#108
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5774
Practice Address - Country:US
Practice Address - Phone:440-429-3027
Practice Address - Fax:216-291-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00060301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKN9347441Medicare PIN