Basic Information
| Provider Information | |||||||||
| NPI: | 1205316551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNOWLES | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11820 CYPRESS CORNER LN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770651132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818941423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12110 HUFFMEISTER RD. | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818941423 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 4564 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-21-54749 | 01 | BEHAVIOR ANALYST CERTIFICATION BOARD | OTHER |