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General NPI Number Information
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NPI Number | 1245856913
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Entity Type | Organization
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Legal Business Name | PAUL KING-MILLER PSYD LPCC LLC
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 11216 BRENTWOOD HILLS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-3219
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Country | US
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Telephone | 505-670-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 11216 BRENTWOOD HILLS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-3219
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Country | US
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Telephone | 505-670-4684
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Fax |
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Authorized Official
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Title or Position | ONER
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Name | PAUL KING-MILLER
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Credential | LPCC
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Telephone | 505-670-4684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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