MEDICARE: CHERYL KING LPC

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	101YP2500X	Professional Counselor	2007008537	MO

General Provider Information

NPI Number	:	1740412923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL KING LPC

Provider Business Mailing Address
First Line	:	1420 LOUISVILLE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3424
Country	:	US
Telephone Number	:	251-533-3620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 LOUISVILLE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3424
Country	:	US
Telephone Number	:	251-533-3620
Fax Number	:

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

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	08/20/2009

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Directions to “ CHERYL KING LPC” Practice Location

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