Active NPI
Kevin Bruce Knickerbocker, MA, LPC
- Professional Counselor
- Davison, MI
National Provider Identifier
1043929938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401000014
- Practice address
- 8454 N Henderson Rd
Davison, MI 48423-9318 - Phone
- (810) 834-7769
- NPI assigned
- Nov 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401000014 | MI | Primary |
Addresses
Primary practice location
8454 N Henderson Rd
Davison, MI 48423-9318
Mailing address
8454 N Henderson Rd
Davison, MI 48423-9318
Phone (810) 834-7769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401000014 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668729600000",
"number": "1043929938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8454 N HENDERSON RD",
"city": "DAVISON",
"state": "MI",
"postal_code": "484239318",
"telephone_number": "810-834-7769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8454 N HENDERSON RD",
"city": "DAVISON",
"state": "MI",
"postal_code": "484239318",
"telephone_number": "810-834-7769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNICKERBOCKER",
"first_name": "KEVIN",
"middle_name": "BRUCE",
"credential": "MA, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-18",
"last_updated": "2022-11-18",
"certification_date": "2022-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401000014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davison, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.