Provider Demographics
NPI:1720229172
Name:CARSWELL, KENNETH (MS, BCPC, PTSDC, CDC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:CARSWELL
Suffix:
Gender:M
Credentials:MS, BCPC, PTSDC, CDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 WHITEAKER RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-8076
Mailing Address - Country:US
Mailing Address - Phone:870-718-6007
Mailing Address - Fax:
Practice Address - Street 1:6120 WHITEAKER RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-8076
Practice Address - Country:US
Practice Address - Phone:870-718-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 171M00000X, 101YP1600X, 103K00000X
FLIMH 13452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst