Provider Demographics
NPI:1558723031
Name:KING, GARNETTA
Entity Type:Individual
Prefix:MRS
First Name:GARNETTA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2604
Mailing Address - Country:US
Mailing Address - Phone:913-831-2820
Mailing Address - Fax:913-831-0262
Practice Address - Street 1:803 ARMSTRONG AVE
Practice Address - Street 2:ASSOCIATED YOUTH SERVICES
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101
Practice Address - Country:US
Practice Address - Phone:913-831-2820
Practice Address - Fax:913-831-0262
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS369101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)