Provider Demographics
NPI:1831272681
Name:KING, LINDA R (MFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671306
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-1306
Mailing Address - Country:US
Mailing Address - Phone:907-688-5662
Mailing Address - Fax:
Practice Address - Street 1:1825 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5391
Practice Address - Country:US
Practice Address - Phone:907-522-7080
Practice Address - Fax:907-522-7088
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK230OtherALASKA LICENSE #