1306837604 NPI number — MR. KEN W KUSCHEL MA, LPC

Table of content: MR. KEN W KUSCHEL MA, LPC (NPI 1306837604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306837604 NPI number — MR. KEN W KUSCHEL MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUSCHEL
Provider First Name:
KEN
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306837604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 CRESTVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONETT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65708-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-229-2548
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 S MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65605-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-678-6233
Provider Business Practice Location Address Fax Number:
417-847-1765
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2002026260 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11408272 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 495100174 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com