| Amy King Lcsw Llc | |
|
1611 Se Riviera Dr Bend OR 97702-1814 | |
| (541) 350-2905 | |
| Not Available |
| Full Name | Amy King Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1611 Se Riviera Dr, Bend, Oregon |
| Authorized Official Name and Position | Amy King (OWNER) |
| Authorized Official Contact | 5413502905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy King Lcsw Llc Po Box 8071 Bend OR 97708-8071 Ph: (541) 350-2905 | Amy King Lcsw Llc 1611 Se Riviera Dr Bend OR 97702-1814 Ph: (541) 350-2905 |
| NPI Number | 1750629911 |
|---|---|
| Provider Enumeration Date | 01/23/2013 |
| Last Update Date | 10/11/2023 |
| Certification Date | 10/11/2023 |
| Medicare PECOS PAC ID | 0941658033 |
|---|---|
| Medicare Enrollment ID | O20231130000420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750629911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | L3167 (Oregon) | Primary |
| Provider Name | Amy Fisher King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932498524 PECOS PAC ID: 0648415901 Enrollment ID: I20130315000034 |
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