Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 22327 | TX |
N | 103T00000X | Psychologist | 22327 | TX |
N | 103TH0100X | Health Service | 22327 | TX |
NPI | 1477688505 |
---|---|
Provider Name | Deborah Martin King |
First Address | Austin, TX 78759-8661 |
Second Address | Austin, TX 78759-8661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A79L | BLUE CROSS BLUE SHIELD (01) | TX |
P000A79L6 | (05) | TX |