Provider Demographics
NPI:1972712206
Name:KING, AMY SUZANNE (MA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:KING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 N 63RD PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7708
Mailing Address - Country:US
Mailing Address - Phone:480-610-6996
Mailing Address - Fax:480-610-1502
Practice Address - Street 1:43 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1446
Practice Address - Country:US
Practice Address - Phone:480-610-6996
Practice Address - Fax:480-610-1502
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMFT0469106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist