Provider Demographics
NPI:1467413856
Name:KING, JEFFREY J (LMSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8074 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1641
Mailing Address - Country:US
Mailing Address - Phone:248-547-8083
Mailing Address - Fax:
Practice Address - Street 1:30555 SOUTHFIELD RD STE 510
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1221
Practice Address - Country:US
Practice Address - Phone:248-642-8263
Practice Address - Fax:248-642-6832
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071109207P00000X, 207PE0004X, 207PH0002X
MI68011027241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103490246Medicaid
MI104696432Medicaid
MIJK071109OtherBC/BS OF MI
MI103490237Medicaid
MIG84776Medicare UPIN
MI103490246Medicaid
MIM16430015Medicare PIN