Provider Demographics
NPI:1508147836
Name:KING, JOSEPH JR (CAS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:KING
Suffix:JR
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3916 PENN MAR AVE APT I
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-2482
Mailing Address - Country:US
Mailing Address - Phone:626-453-3411
Mailing Address - Fax:626-453-3415
Practice Address - Street 1:4610 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1311
Practice Address - Country:US
Practice Address - Phone:626-453-3411
Practice Address - Fax:626-453-3415
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)