Provider Demographics
NPI:1720130560
Name:KING, JANICE A (LMHC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:A
Last Name:KING
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9638 CARINE CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9372
Mailing Address - Country:US
Mailing Address - Phone:260-485-2854
Mailing Address - Fax:
Practice Address - Street 1:525 E 200 N
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7532
Practice Address - Country:US
Practice Address - Phone:260-665-8402
Practice Address - Fax:260-665-8403
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000730A101YM0800X
IN35001356A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39000730AOtherMENTAL HEALTH COUNSELOR
IN35001356AOtherMARRIAGE & FAMILY