Provider Demographics
NPI:1902091531
Name:KNUTSON, DARREL RICHARD (LMHC MA)
Entity Type:Individual
Prefix:MR
First Name:DARREL
Middle Name:RICHARD
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:LMHC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16778
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-6778
Mailing Address - Country:US
Mailing Address - Phone:505-489-1283
Mailing Address - Fax:505-292-4116
Practice Address - Street 1:4225 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1103
Practice Address - Country:US
Practice Address - Phone:505-881-1820
Practice Address - Fax:505-881-1850
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0107091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional