Healthcare Provider Details

I. General information

NPI: 1427298447
Provider Name (Legal Business Name): RICHARD M. KING MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 VAN NESS AVE FL 3
SAN FRANCISCO CA
94109-3608
US

IV. Provider business mailing address

PO BOX 7999
SAN FRANCISCO CA
94120-7999
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6200
  • Fax: 415-749-1433
Mailing address:
  • Phone: 415-600-2683
  • Fax: 415-749-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT41112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: