Basic Information
| Provider Information | |||||||||
| NPI: | 1487069753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARSENAULT | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCPCC MHRTC CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044020936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079454240 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079454240 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 08/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | XL4256 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.