Provider Demographics
NPI:1649665159
Name:KNIP, LEEANN (LCSW)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:KNIP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MESQUITE AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5685
Mailing Address - Country:US
Mailing Address - Phone:928-662-9766
Mailing Address - Fax:
Practice Address - Street 1:1930 MESQUITE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5685
Practice Address - Country:US
Practice Address - Phone:928-662-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-225471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical