Provider Demographics
NPI:1689983231
Name:KING, MICHELLE (JD, LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:JD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300051
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0051
Mailing Address - Country:US
Mailing Address - Phone:346-201-8971
Mailing Address - Fax:
Practice Address - Street 1:2425 SOUTHMORE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7418
Practice Address - Country:US
Practice Address - Phone:346-201-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65313101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216401401Medicaid