Provider Demographics
NPI:1528238334
Name:KING, CEDRIC (MFT)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:OASIS
Other - Middle Name:FOR
Other - Last Name:HEALING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:225 S CIVIC DR
Mailing Address - Street 2:SUITE 2-12
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7226
Mailing Address - Country:US
Mailing Address - Phone:760-221-9397
Mailing Address - Fax:760-671-4879
Practice Address - Street 1:225 S CIVIC DR
Practice Address - Street 2:SUITE 2-12
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7226
Practice Address - Country:US
Practice Address - Phone:760-221-9397
Practice Address - Fax:760-671-4879
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97310071E06338OtherMEDI CAL BENEFITS CARD