Provider Demographics
NPI:1669200937
Name:KING, NEIL ALEXANDER (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:ALEXANDER
Last Name:KING
Suffix:
Gender:M
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20195 MALLARD WAY
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-8991
Mailing Address - Country:US
Mailing Address - Phone:763-645-7083
Mailing Address - Fax:
Practice Address - Street 1:1230 SCHOOL ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2422
Practice Address - Country:US
Practice Address - Phone:763-241-3558
Practice Address - Fax:763-241-3540
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306387101YA0400X
MNCC04495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)