Provider Demographics
NPI:1386514792
Name:KNOWLTON, MIKA (COUNSELOR)
Entity type:Individual
Prefix:
First Name:MIKA
Middle Name:
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 CENTENNIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2474
Mailing Address - Country:US
Mailing Address - Phone:541-984-3118
Mailing Address - Fax:541-780-6375
Practice Address - Street 1:2145 CENTENNIAL PLZ
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2474
Practice Address - Country:US
Practice Address - Phone:541-984-3118
Practice Address - Fax:541-780-6375
Is Sole Proprietor?:No
Enumeration Date:2025-11-10
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10028330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor