Provider Demographics
NPI:1861112971
Name:KING, SHANTRAIL (LPC-A)
Entity type:Individual
Prefix:
First Name:SHANTRAIL
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N WALL ST UNIT 1086
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-0105
Mailing Address - Country:US
Mailing Address - Phone:254-450-2950
Mailing Address - Fax:
Practice Address - Street 1:600 CLIFF DRIVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513
Practice Address - Country:US
Practice Address - Phone:254-450-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health