Provider Demographics
NPI:1558334292
Name:KING, MICHAEL K (LPC LSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:KING
Suffix:
Gender:M
Credentials:LPC LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-0817
Mailing Address - Country:US
Mailing Address - Phone:937-465-8065
Mailing Address - Fax:937-465-3505
Practice Address - Street 1:1521 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-0817
Practice Address - Country:US
Practice Address - Phone:937-465-8065
Practice Address - Fax:937-465-3505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0005786101YP2500X
OHS0013797104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker