Provider Demographics
NPI:1598473316
Name:MARY BETH KING COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:MARY BETH KING COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, CSAC
Authorized Official - Phone:920-857-1080
Mailing Address - Street 1:1345 W MASON ST STE 116
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2049
Mailing Address - Country:US
Mailing Address - Phone:920-857-1080
Mailing Address - Fax:920-857-1084
Practice Address - Street 1:1345 W MASON ST STE 116
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2049
Practice Address - Country:US
Practice Address - Phone:920-857-1080
Practice Address - Fax:920-857-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health