Provider Demographics
NPI:1821011891
Name:KING, JEFFREY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 TIMOTHY CT
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7809
Mailing Address - Country:US
Mailing Address - Phone:360-630-7355
Mailing Address - Fax:360-756-5157
Practice Address - Street 1:3923 TIMOTHY CT
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7809
Practice Address - Country:US
Practice Address - Phone:360-630-7355
Practice Address - Fax:360-756-5157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1771103TC0700X
WAPY60462687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07017718Medicaid
CO68796Medicare ID - Type Unspecified