MEDICARE: CAMILLE E BOSWELL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A1801002	AR
2	101YP2500X	Professional Counselor	P1907087	AR

General Provider Information

NPI Number	:	1053788877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE E BOSWELL LPC

Provider Business Mailing Address
First Line	:	PO BOX 324
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72702-0324
Country	:	US
Telephone Number	:	479-310-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 N BLOCK AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5204
Country	:	US
Telephone Number	:	479-310-0061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	02/09/2026

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Directions to “ CAMILLE E BOSWELL LPC” Practice Location

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