Provider Demographics
NPI:1225914096
Name:KING, KACEY (MS, MFT-IT)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MS, MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2462
Mailing Address - Country:US
Mailing Address - Phone:612-963-8315
Mailing Address - Fax:
Practice Address - Street 1:2217 VINE ST STE 206
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-5888
Practice Address - Country:US
Practice Address - Phone:715-441-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1184-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist