Basic Information
| Provider Information | |||||||||
| NPI: | 1275847816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | LEANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.ED., LPC, BSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1307 AIRPORT RD N | ||||||||
| Address2: | SUITE B | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392328897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7692338239 | ||||||||
| FaxNumber: | 7692337865 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 AIRPORT RD N | ||||||||
| Address2: | SUITE B | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392328897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7692338239 | ||||||||
| FaxNumber: | 7692337865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2010 | ||||||||
| LastUpdateDate: | 04/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1174 | MS | N | Behavioral Health & Social Service Providers | Counselor | Professional | 163W00000X | R883646 | MS | Y | Nursing Service Providers | Registered Nurse |
No ID Information.