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NPI Code Detail

MEDICARE: DR. KENNETH HAROLD KASNER PH.D.

MEDICARE: DR. KENNETH HAROLD KASNER PH.D.
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
1101YM0800XMental Health Counselor1136AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11154574150OTHERAZNPI

General Provider Information

NPI Number : 1720250848
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH HAROLD KASNER PH.D.
Provider Business Mailing Address
First Line : PO BOX 10277
Second Line :
City : PRESCOTT
State : AZ
Zip : 86304-0277
Country : US
Telephone Number : 928-778-2925
Fax Number :
Provider Business Practice Location Address
First Line : 1129 W IRON SPRINGS RD
Second Line :
City : PRESCOTT
State : AZ
Zip : 86305-1623
Country : US
Telephone Number : 928-778-2925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2008
Last Update Date : 02/15/2015

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