MEDICARE: MS. KAREN RANEE BARDWELL MSW, QMHP

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	68692	TX

General Provider Information

NPI Number	:	1992272892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN RANEE BARDWELL MSW, QMHP

Provider Business Mailing Address
First Line	:	PO BOX 962
Second Line	:
City	:	POTTSBORO
State	:	TX
Zip	:	75076-0962
Country	:	US
Telephone Number	:	903-771-8731
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 S MAGNOLIA ST
Second Line	:
City	:	POTTSBORO
State	:	TX
Zip	:	75076-3058
Country	:	US
Telephone Number	:	903-771-8731
Fax Number	:

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	10/20/2025

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