Healthcare Provider Details

I. General information

NPI: 1336408533
Provider Name (Legal Business Name): KEVIN LAVELLE BARNETT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 W 6TH AVE
PINE BLUFF AR
71601-3927
US

IV. Provider business mailing address

1219 W 6TH AVE
PINE BLUFF AR
71601-3927
US

V. Phone/Fax

Practice location:
  • Phone: 870-395-7188
  • Fax:
Mailing address:
  • Phone: 870-395-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8667-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: