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NPI Code Detail

MEDICARE: DR. LOLITA KING-BETHEL PHD, LP, LICSW

MEDICARE: DR. LOLITA KING-BETHEL PHD, LP, LICSW
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
1103T00000XPsychologistLP4593MN
21041C0700XClinical Social Worker25097MN

General Provider Information

NPI Number : 1073540753
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOLITA KING-BETHEL PHD, LP, LICSW
Provider Business Mailing Address
First Line : 1501 XERXES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2851
Country : US
Telephone Number : 763-522-0100
Fax Number :
Provider Business Practice Location Address
First Line : 1501 XERXES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2851
Country : US
Telephone Number : 763-522-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 01/30/2026

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