Provider Demographics
NPI:1851490361
Name:KING, THOMAS EDWARD (MSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:KING
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3820 CLEVELAND AVE N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3285
Mailing Address - Country:US
Mailing Address - Phone:651-389-4402
Mailing Address - Fax:651-389-4410
Practice Address - Street 1:3820 CLEVELAND AVE N
Practice Address - Street 2:SUITE 400
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3285
Practice Address - Country:US
Practice Address - Phone:651-389-4402
Practice Address - Fax:651-389-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN05391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6272579OtherUNITED BEHAVIORAL HEALTH
MNHP23667OtherHEALTH PARTNERS
MN79B37KIOtherBLUE CROSS/BLUE SHIELD