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General NPI Number Information
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NPI Number | 1851050413
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Entity Type | Individual
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Provider Name | CANDACE MICHELLE BOSWELL LPC
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Gender | Female
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 702 N MAIN ST STE F
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City | HARRISON
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State | AR
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Zip | 72601-2920
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Country | US
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Telephone | 870-340-2636
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Fax | 833-226-0134
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Provider Business Mailing Address
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Address Line | 10800 FINANCIAL CENTRE PKWY STE 290
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3581
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Country | US
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Telephone | 870-340-2636
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Fax | 888-816-7916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A2203012
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License Number State | AR
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