Provider Demographics
NPI:1417828625
Name:KING, MICHAEL E
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 FISK RD
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-6718
Mailing Address - Country:US
Mailing Address - Phone:616-965-5483
Mailing Address - Fax:
Practice Address - Street 1:301 FISK RD
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6718
Practice Address - Country:US
Practice Address - Phone:616-965-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician