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General NPI Number Information
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NPI Number | 1871115337
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Entity Type | Individual
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Provider Name | MELISSA JEAN KING PHD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 205 W 2ND ST STE 437
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City | DULUTH
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State | MN
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Zip | 55802-1922
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Country | US
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Telephone | 218-722-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 525 N MANHATTAN AVE APT 11
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City | MANHATTAN
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State | KS
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Zip | 66502-5370
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Country | US
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Telephone | 525-991-7280
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6535
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License Number State | MN
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