Provider Demographics
NPI:1386924488
Name:KING, NATHANIAL D (PSS)
Entity type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:D
Last Name:KING
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:PATRIC
Other - Last Name:SAENZ
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 SE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6018
Mailing Address - Country:US
Mailing Address - Phone:503-472-4783
Mailing Address - Fax:
Practice Address - Street 1:320 SE DAVIS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6018
Practice Address - Country:US
Practice Address - Phone:503-472-4783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health