Provider Demographics
NPI:1871013086
Name:KING, WESLEY (MA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 TURTLEBAY AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1256
Mailing Address - Country:US
Mailing Address - Phone:702-429-3068
Mailing Address - Fax:
Practice Address - Street 1:3243 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3185
Practice Address - Country:US
Practice Address - Phone:702-434-7290
Practice Address - Fax:702-434-6940
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP-5700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional