MEDICARE: MS. MARY KING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	101YM0800X	Mental Health Counselor	71646	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	71646	TX
4	101Y00000X	Counselor	71646	TX
5	101YP2500X	Professional Counselor	71646	TX
6	106H00000X	Marriage & Family Therapist	71646	TX
7	101YS0200X	School Counselor	71646	TX
8	102L00000X	Psychoanalyst	71646	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	840LQB	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063719904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KING

Provider Business Mailing Address
First Line	:	6308 SNOW RIDGE CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-3160
Country	:	US
Telephone Number	:	817-648-9298
Fax Number	:

Provider Business Practice Location Address
First Line	:	6308 SNOW RIDGE CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-3160
Country	:	US
Telephone Number	:	817-648-9298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	03/23/2016

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Directions to “ MS. MARY KING ” Practice Location

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