MEDICARE: JORDAN KING MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH20207	FL
2	101YM0800X	Mental Health Counselor	MI-0000295	DE
3	101YM0800X	Mental Health Counselor	14235386-6004	UT

General Provider Information

NPI Number	:	1730844291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN KING MA

Provider Business Mailing Address
First Line	:	35179 BRIENNE ST
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33541-5088
Country	:	US
Telephone Number	:	813-816-1457
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 ALLEN RD # 1015
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33541-3551
Country	:	US
Telephone Number	:	813-816-1457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	03/03/2026

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Directions to “ JORDAN KING MA” Practice Location

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