Basic Information
| Provider Information | |||||||||
| NPI: | 1376798041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | MERRILL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 EDGEWATER ST NW | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973044049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885816 | ||||||||
| FaxNumber: | 5035885803 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 EDGEWATER ST NW | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973044049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885816 | ||||||||
| FaxNumber: | 5035885803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2008 | ||||||||
| LastUpdateDate: | 09/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC32869 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | T0687 | OR | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.