Provider Demographics
NPI:1285079889
Name:KNOWLES, RODERICK VINCENT JR (BHRS/CASE MANAGER)
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:VINCENT
Last Name:KNOWLES
Suffix:JR
Gender:M
Credentials:BHRS/CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11632 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1369
Mailing Address - Country:US
Mailing Address - Phone:918-294-3012
Mailing Address - Fax:
Practice Address - Street 1:11632 E 64TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1369
Practice Address - Country:US
Practice Address - Phone:918-294-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health