Provider Demographics
NPI:1629124805
Name:KING, DANIEL MARTIN (LISW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARTIN
Last Name:KING
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 TOWNSHIP ROAD 120
Mailing Address - Street 2:
Mailing Address - City:MC COMB
Mailing Address - State:OH
Mailing Address - Zip Code:45858-9777
Mailing Address - Country:US
Mailing Address - Phone:419-293-3112
Mailing Address - Fax:
Practice Address - Street 1:300 W WALLACE ST
Practice Address - Street 2:A1
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1242
Practice Address - Country:US
Practice Address - Phone:419-423-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00041611041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist