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General NPI Number Information
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NPI Number | 1578929626
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Entity Type | Organization
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Legal Business Name | KENNETH CARSWELL, LLC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 6120 WHITEAKER RD
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City | PINE BLUFF
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State | AR
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Zip | 71603-8076
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Country | US
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Telephone | 870-718-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 6120 WHITEAKER RD
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City | PINE BLUFF
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State | AR
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Zip | 71603-8076
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Country | US
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Telephone | 870-718-6007
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KENNETH CARSWELL
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Credential | MS, BCPC, PTSDC, CDC
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Telephone | 870-718-6007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | IMH 13452
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License Number State | FL
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