Healthcare Provider Details

I. General information

NPI: 1487796512
Provider Name (Legal Business Name): JULIE LYNN KING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SW COLORADO AVE STE 130
BEND OR
97702-1148
US

IV. Provider business mailing address

15 SW COLORADO AVE STE 130
BEND OR
97702-1148
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-3534
  • Fax:
Mailing address:
  • Phone: 541-388-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1251
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1251
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1251
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1251
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: