MEDICARE: COLLEEN 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	1041C0700X	Clinical Social Worker	58343	TX

General Provider Information

NPI Number	:	1073966289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN KING

Provider Business Mailing Address
First Line	:	2309 BALSAM DR APT K306
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-5958
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 BALSAM DR APT K306
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-5958
Country	:	US
Telephone Number	:	817-707-8971
Fax Number	:

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

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	07/22/2016

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Directions to “ COLLEEN KING ” Practice Location

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