Individual
PETER KINGSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(701) 723-5633
Mailing address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(701) 723-5633
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW61205441
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14615066
CAQH
—
Enumeration date
07/10/2018
Last updated
01/04/2024
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