MIKE KNICKERBOCKER (NPI# 1770847485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| 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 |
| 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 |
| Street Address |
412 YORK ST |
| City | WARREN |
| State | AR |
| Zip Code | 71671-3218 |
| 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 |
| 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 Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| 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 | ||||
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| 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.