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General NPI Number Information
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NPI Number | 1477942340
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Entity Type | Organization
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Legal Business Name | KING THERAPIES
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 102 MAIN ST W
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City | NEW ALBANY
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State | MS
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Zip | 38652-3323
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Country | US
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Telephone | 662-266-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 102 WEST MAIN STREET
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City | NEW ALBANY
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State | MS
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Zip | 38652
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BAILEY KING
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Credential | MA,BCBA
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Telephone | 662-266-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-17074
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License Number State | MS
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