Healthcare Provider Details

I. General information

NPI: 1255262143
Provider Name (Legal Business Name): MICHELE ROBIN KING LAC, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S CIRCLE DR
BAILEY CO
80421-2020
US

IV. Provider business mailing address

60 S CIRCLE DR
BAILEY CO
80421-2020
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-4575
  • Fax: 303-945-4366
Mailing address:
  • Phone: 720-536-4575
  • Fax: 303-945-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01819
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: