Healthcare Provider Details

I. General information

NPI: 1093215220
Provider Name (Legal Business Name): ANDREW KING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 S EASTERN AVE STE 109
LAS VEGAS NV
89123-2515
US

IV. Provider business mailing address

732 S 6TH ST STE R
LAS VEGAS NV
89101-6948
US

V. Phone/Fax

Practice location:
  • Phone: 775-600-6994
  • Fax:
Mailing address:
  • Phone: 775-401-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP6340
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: