Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 71646 | TX |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 71646 | TX |
N | 101YM0800X | Mental Health Counselor | 71646 | TX |
Y | 101YP2500X | Professional Counselor | 71646 | TX |
N | 101YS0200X | School Counselor | 71646 | TX |
N | 102L00000X | Psychologist | 71646 | TX |
N | 103T00000X | Psychologist | 71646 | TX |
NPI | 1063719904 |
---|---|
Provider Name | Ms. Mary King |
First Address | Arlington, TX 76018-3160 |
Second Address | Arlington, TX 76018-3160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2011 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
352705301 | (05) | TX |
352705302 | (05) | TX |
840LQB | BLUE CROSS BLUE SHIELD (01) | TX |