Provider Demographics
NPI:1497953426
Name:ATWELL, BENJAMIN LOUIS JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LOUIS
Last Name:ATWELL
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2177 S CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2848
Mailing Address - Country:US
Mailing Address - Phone:417-886-1821
Mailing Address - Fax:417-887-8609
Practice Address - Street 1:1540 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4300
Practice Address - Country:US
Practice Address - Phone:417-823-2900
Practice Address - Fax:417-886-2774
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030322021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical