Provider Demographics
NPI:1073774642
Name:KING, URSULA GABRIELE (MFT)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:GABRIELE
Last Name:KING
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 CAREY DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4816
Mailing Address - Country:US
Mailing Address - Phone:530-274-3812
Mailing Address - Fax:
Practice Address - Street 1:10405 CAREY DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4816
Practice Address - Country:US
Practice Address - Phone:530-274-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist