Provider Demographics
NPI:1720250848
Name:KASNER, KENNETH HAROLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HAROLD
Last Name:KASNER
Suffix:
Gender:M
Credentials:PHD
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 10277
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0277
Mailing Address - Country:US
Mailing Address - Phone:928-778-2925
Mailing Address - Fax:
Practice Address - Street 1:1129 W IRON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1623
Practice Address - Country:US
Practice Address - Phone:928-778-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1154574150OtherNPI