Provider Demographics
NPI:1396113015
Name:CARSWELL, KENDAL JAY SR (LMSW, LCAC)
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:JAY
Last Name:CARSWELL
Suffix:SR
Gender:M
Credentials:LMSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E THORPE ST
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9625
Mailing Address - Country:US
Mailing Address - Phone:785-355-7112
Mailing Address - Fax:785-355-8636
Practice Address - Street 1:500 E THORPE ST
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-9625
Practice Address - Country:US
Practice Address - Phone:785-355-7112
Practice Address - Fax:785-355-8636
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS001101YA0400X
KS5645104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)