Provider Demographics
NPI:1366853657
Name:SWEENEY KNIEP, DAWN PATRICIA (LMFT, LCMFT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:PATRICIA
Last Name:SWEENEY KNIEP
Suffix:
Gender:F
Credentials:LMFT, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1914
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-1914
Mailing Address - Country:US
Mailing Address - Phone:316-641-3378
Mailing Address - Fax:855-523-6066
Practice Address - Street 1:863 PACIFIC ST.
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:316-351-8684
Practice Address - Fax:855-523-6066
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2856106H00000X
CA151058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004555730001Medicaid