Provider Demographics
NPI:1629758883
Name:KING, LEWIS MILLER III (BA)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:MILLER
Last Name:KING
Suffix:III
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6335
Mailing Address - Country:US
Mailing Address - Phone:928-293-0755
Mailing Address - Fax:
Practice Address - Street 1:2830 E GORDON DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2736
Practice Address - Country:US
Practice Address - Phone:928-530-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral