Provider Demographics
NPI:1568984144
Name:KING, KELLY (MA, NLC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MA, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5946
Mailing Address - Country:US
Mailing Address - Phone:720-214-0808
Mailing Address - Fax:
Practice Address - Street 1:2425 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5946
Practice Address - Country:US
Practice Address - Phone:720-214-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)