Provider Demographics
NPI:1558013821
Name:KING, CLARA (LMSW)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12375 COUNTY ROAD 2030
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-7828
Mailing Address - Country:US
Mailing Address - Phone:573-261-0837
Mailing Address - Fax:
Practice Address - Street 1:12375 COUNTY ROAD 2030
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-7828
Practice Address - Country:US
Practice Address - Phone:573-261-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021047637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker