Provider Demographics
NPI:1205172905
Name:KING, MAKINI LATEEFAH (MA)
Entity type:Individual
Prefix:
First Name:MAKINI
Middle Name:LATEEFAH
Last Name:KING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SCHWEGLER DR
Mailing Address - Street 2:RM 2100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 SCHWEGLER DR
Practice Address - Street 2:RM 2100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7559
Practice Address - Country:US
Practice Address - Phone:785-864-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOM203183007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health