Provider Demographics
NPI:1932440609
Name:KNAULS, LATICIA ANNETTE
Entity Type:Individual
Prefix:
First Name:LATICIA
Middle Name:ANNETTE
Last Name:KNAULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATICIA
Other - Middle Name:ANETTE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:205 S J T STITES BLVD
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-9323
Mailing Address - Country:US
Mailing Address - Phone:918-775-7787
Mailing Address - Fax:918-775-0328
Practice Address - Street 1:205 S J T STITES BLVD
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9323
Practice Address - Country:US
Practice Address - Phone:918-775-7787
Practice Address - Fax:918-775-0328
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)