=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346860525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH EVE KING LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2020
-----------------------------------------------------
Last Update Date | 04/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 E MINGUS AVE
-----------------------------------------------------
City | COTTONWOOD
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86326-3746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-600-1926
-----------------------------------------------------
Fax | 928-350-6417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1349 COYOTE RD
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86303-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-600-1926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW.09928557
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW-22180
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------