Provider Demographics
NPI:1760614937
Name:KING, GLENN RICHARD JR (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:RICHARD
Last Name:KING
Suffix:JR
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 BURKE AVE N
Mailing Address - Street 2:STE 220
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9054
Mailing Address - Country:US
Mailing Address - Phone:206-486-0984
Mailing Address - Fax:206-681-9647
Practice Address - Street 1:3301 BURKE AVE N
Practice Address - Street 2:STE 220
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9054
Practice Address - Country:US
Practice Address - Phone:206-486-0984
Practice Address - Fax:206-681-9647
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60269994101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor