Provider Demographics
NPI:1366525818
Name:KING, WALTER HAROLD (MFT)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:HAROLD
Last Name:KING
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22621 LYONS AVE
Mailing Address - Street 2:205
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1702
Mailing Address - Country:US
Mailing Address - Phone:661-287-9337
Mailing Address - Fax:661-253-4164
Practice Address - Street 1:22621 LYONS AVE
Practice Address - Street 2:205
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-1702
Practice Address - Country:US
Practice Address - Phone:661-287-9337
Practice Address - Fax:661-253-4164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist