MIKE KNICKERBOCKER


Address: 412 York St, Warren, AR 71671-3218
Phone: 8702269970

MIKE KNICKERBOCKER (NPI# 1770847485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1770847485
Entity Type Individual
Full Name MIKE KNICKERBOCKER
Credential LADAC
Practice Address 412 York St
Warren
AR 71671-3218
Practice Telephone 8702269970
Practice Fax Number 8702269972
Mailing Telephone 8702269970
Mailing Fax Number 8702269972
Enumeration Date 2012-06-27
Last Update Date 2012-06-27
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
A-194 AR Behavioral Health & Social Service Providers
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
0159L AR Behavioral Health & Social Service Providers

Office Location

Street Address 412 YORK ST
City WARREN
State AR
Zip Code 71671-3218

Providers in the same location

NPI Name Taxonomy Address Enumeration
1376805515 10th District Substance Abuse Treatment Center Substance Abuse Rehabilitation Facility 412 York St, Warren, AR 71671-3218 2012-06-13
1598221483 Keith Newton Case Manager/Care Coordinator 412 York St, Warren, AR 71671-3218 2019-02-15
1003394602 Scott Allison Johnson Counselor 412 York St, Warren, AR 71671-3218 2018-08-06

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1992116396 Bradley Newton Biggers Family Medicine 304 E Central St., Warren, AR 71671 2014-05-19
1558602003 Kelley M Hollingsworth Licensed Practical Nurse 1404 East Church Street, Warren, AR 71671 2013-03-08
1245516228 Lauren Lynch Pharmacist 507 W Pine, Warren, AR 71671 2011-10-22
1114237062 Gary Maskell Chiropractor 210 East Shields Street, Warren, AR 71671 2010-10-13
1841442811 Wagnon Place Health Facilities Skilled Nursing Facility 1440 East Church Street, Warren, AR 71671 2008-10-21
1104953629 Kathryn Kelly Cash Speech-Language Pathologist 206 Bragg St., Warren, AR 71671 2007-02-28
1477628352 University of Arkansas for Medical Sciences Pediatrics 222 E Central St, Warren, AR 71671 2006-11-23
1649383514 Karen Walker Social Worker 1404 E Church, Warren, AR 71671 2006-08-16
1699705178 Rosemary Bell Licensed Practical Nurse 1404 E Church St, Warren, AR 71671 2006-07-03
1992348551 Charles C Gibson Case Manager/Care Coordinator 1404 E Church St, Warren, AR 71671 2019-10-25
Find all providers in zip 71671

Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1932747888 Open Water Counseling and Recovery, LLC Counselor 1725 Drexel Ave Nw, Warren, OH 44485-2121 2019-12-11
1124663935 A Restored Outlook LLC Counselor 8287 Linda St, Warren, MI 48093-2838 2019-11-15
1063075356 Just Ask and I'll Help Mental Health Services Counselor 29648 City Center Dr Apt 3, Warren, MI 48093-2415 2019-04-22
1598273963 Luke Charles Metcalf Counselor 1212 Tod Pl Nw, Warren, OH 44485-2475 2018-01-18
1518405018 Rachel Soroka Counselor 160 Clifton Dr Ne, Warren, OH 44484-1820 2017-02-03
1538528534 Joseph Burger Counselor 13520 Dominic Dr, Warren, MI 48088-1817 2016-02-18
1164890224 Lashella Savage Counselor 14160 E 14 Mile Rd, Warren, MI 48088-5701 2015-09-07
1053728030 Jane Kennedy Bays Counselor 30521 Schoenherr Rd Ste 200, Warren, MI 48088 2014-07-22
1073851044 Michael Andrew Perkins Counselor 21760 Logue Ave, Warren, MI 48091-2352 2013-01-24
1194069245 Latina Marie Johnson Counselor 29192 Aline Dr, Warren, MI 48093-2691 2012-11-15
Find all providers in WARREN

Competitor

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City WARREN
Zip Code 71671

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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