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General NPI Number Information
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NPI Number | 1649717323
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Entity Type | Individual
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Provider Name | STACEY KING
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Gender | Female
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 572 N ARROWHEAD AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1251
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Country | US
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Telephone | 909-781-1596
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Fax |
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Provider Business Mailing Address
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Address Line | 25124 FIR AVE APT 44
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City | MORENO VALLEY
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State | CA
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Zip | 92553-2307
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Country | US
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Telephone | 951-255-1320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW119115
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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