Provider Demographics
NPI:1295910974
Name:PRIEST, KENNETH ALDWIN (MS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALDWIN
Last Name:PRIEST
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0344
Mailing Address - Country:US
Mailing Address - Phone:501-450-6350
Mailing Address - Fax:
Practice Address - Street 1:2323 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-2766
Practice Address - Country:US
Practice Address - Phone:501-450-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR89-19EI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling