Provider Demographics
NPI:1861426942
Name:OLIVER-KING, JENNIFER (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OLIVER-KING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 E FISH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2832
Mailing Address - Country:US
Mailing Address - Phone:612-239-5055
Mailing Address - Fax:763-424-8315
Practice Address - Street 1:7026 E FISH LAKE RD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2832
Practice Address - Country:US
Practice Address - Phone:612-239-5055
Practice Address - Fax:763-424-8315
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT 1526106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN374896100Medicaid
MNHP59862OtherHEALTH PARTNERS
MN906590LOtherBCBS