Provider Demographics
NPI:1437608544
Name:KNAUF, CARLEEN VICTORIA (PSYD)
Entity type:Individual
Prefix:
First Name:CARLEEN
Middle Name:VICTORIA
Last Name:KNAUF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6074 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9619
Mailing Address - Country:US
Mailing Address - Phone:269-470-1100
Mailing Address - Fax:
Practice Address - Street 1:4503 SEAWAY CIR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3379
Practice Address - Country:US
Practice Address - Phone:269-470-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA33039103T00000X
CO0005630103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health