Healthcare Provider Details

I. General information

NPI: 1851050413
Provider Name (Legal Business Name): CANDACE MICHELLE BOSWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MAIN ST STE F
HARRISON AR
72601-2920
US

IV. Provider business mailing address

10800 FINANCIAL CENTRE PKWY STE 290
LITTLE ROCK AR
72211-3581
US

V. Phone/Fax

Practice location:
  • Phone: 870-340-2636
  • Fax: 833-226-0134
Mailing address:
  • Phone: 870-340-2636
  • Fax: 888-816-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA2203012
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: