MEDICARE: JEFFREY J KING LMFT

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	106H00000X	Marriage & Family Therapist	LMFT732	KS

General Provider Information

NPI Number	:	1669417606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY J KING LMFT

Provider Business Mailing Address
First Line	:	23033 N 4TH ST
Second Line	:
City	:	OSAGE CITY
State	:	KS
Zip	:	66523-9238
Country	:	US
Telephone Number	:	785-528-3553
Fax Number	:

Provider Business Practice Location Address
First Line	:	23033 N 4TH ST
Second Line	:
City	:	OSAGE CITY
State	:	KS
Zip	:	66523-9238
Country	:	US
Telephone Number	:	785-528-3553
Fax Number	:

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	12/05/2008

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