Provider Demographics
NPI:1700077906
Name:KING, CHERYL ANN (MFTI INTERN)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:MFTI INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94203
Mailing Address - Country:US
Mailing Address - Phone:650-321-3055
Mailing Address - Fax:650-321-3785
Practice Address - Street 1:555 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94203
Practice Address - Country:US
Practice Address - Phone:650-321-3055
Practice Address - Fax:650-321-3785
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist