Provider Demographics
NPI:1295085447
Name:KNIGHT, JERRY
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 COHASSET RD STE 165
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2460
Mailing Address - Country:US
Mailing Address - Phone:530-879-3950
Mailing Address - Fax:530-879-3949
Practice Address - Street 1:560 COHASSET RD STE 165
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2460
Practice Address - Country:US
Practice Address - Phone:530-879-3950
Practice Address - Fax:530-893-3748
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAK1205021228101YA0400X
CAAII15740616101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)