Provider Demographics
NPI:1952035982
Name:KING, JOHN EDWARD (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:KING
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1511
Mailing Address - Country:US
Mailing Address - Phone:702-474-4104
Mailing Address - Fax:702-474-4108
Practice Address - Street 1:2887 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1511
Practice Address - Country:US
Practice Address - Phone:702-474-4104
Practice Address - Fax:702-474-4108
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)