MEDICARE: MRS. DJUANA ALYCE 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		TX

General Provider Information

NPI Number	:	1922516350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DJUANA ALYCE KING LPC

Provider Business Mailing Address
First Line	:	8333 BRAESMAIN DR APT 1342
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2949
Country	:	US
Telephone Number	:	832-724-8428
Fax Number	:

Provider Business Practice Location Address
First Line	:	8333 BRAESMAIN DR APT 1342
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2949
Country	:	US
Telephone Number	:	832-724-8428
Fax Number	:

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

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	07/27/2020

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