Doctor Name: | MR. KENNETH GEORGE FOURNIER |
NPI Number: | 1003170838 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LICSW |
License Number: | 13543 |
Business Practice Address: | 500 N Us Highway 89 Prescott, AZ - 863135001 |
Business Phone Number: | 9284454860 |
Business Fax Number: | 9287766116 |
Mailing Address: | 500 N. Highway 89, PRESCOTT |
State: | AZ |
Postal Code: | 863130000 |
Phone Number: | 9284454860 |
Fax Number: | 9284456116 |
NPI Enumeration Date: | 06/26/2012 |
NPI Last Update Date: | 06/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 13543 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |