Provider Demographics
NPI:1295735108
Name:KNAUSS, MAXWELL R (PHD)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:R
Last Name:KNAUSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S UNION AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1954
Mailing Address - Country:US
Mailing Address - Phone:253-752-7320
Mailing Address - Fax:253-756-0427
Practice Address - Street 1:1530 S UNION AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1954
Practice Address - Country:US
Practice Address - Phone:253-752-7320
Practice Address - Fax:253-756-0427
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8366312Medicaid
WA0010610-03Medicare ID - Type Unspecified