Provider Demographics
NPI:1306837604
Name:KUSCHEL, KEN W (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:W
Last Name:KUSCHEL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1510
Mailing Address - Country:US
Mailing Address - Phone:417-229-2548
Mailing Address - Fax:
Practice Address - Street 1:112 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-1427
Practice Address - Country:US
Practice Address - Phone:417-678-6233
Practice Address - Fax:417-847-1765
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002026260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11408272OtherCAQH
MO495100174Medicaid