1366853657 NPI number — DAWN PATRICIA SWEENEY KNIEP LMFT, LCMFT

Table of content: DAWN PATRICIA SWEENEY KNIEP LMFT, LCMFT (NPI 1366853657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366853657 NPI number — DAWN PATRICIA SWEENEY KNIEP LMFT, LCMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEENEY KNIEP
Provider First Name:
DAWN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT, LCMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366853657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1914
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIPOMO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93444-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-641-3378
Provider Business Mailing Address Fax Number:
855-523-6066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
863 PACIFIC ST.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-351-8684
Provider Business Practice Location Address Fax Number:
855-523-6066
Provider Enumeration Date:
05/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2856 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 151058 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30004555730001 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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