Provider Demographics
NPI:1982460630
Name:KING, KATHLEEN (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66755 TWO BUNCH PALMS TRL
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-5775
Mailing Address - Country:US
Mailing Address - Phone:760-251-7200
Mailing Address - Fax:
Practice Address - Street 1:66755 TWO BUNCH PALMS TRL
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-5775
Practice Address - Country:US
Practice Address - Phone:760-251-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool