Basic Information
Provider Information | |||||||||
NPI: | 1962680470 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ARNTSEN | ||||||||
FirstName: | DONALD | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ARNTSEN | ||||||||
OtherFirstName: | DON | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LPC | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 483 W. SEED FARM RD | ||||||||
Address2: |   | ||||||||
City: | SACATON | ||||||||
State: | AZ | ||||||||
PostalCode: | 85247 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6025287144 | ||||||||
FaxNumber: | 6025281374 | ||||||||
Practice Location | |||||||||
Address1: | 483 W. SEEDF FARM RD | ||||||||
Address2: |   | ||||||||
City: | SACATON | ||||||||
State: | AR | ||||||||
PostalCode: | 85247 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6025287144 | ||||||||
FaxNumber: | 6025251374 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/06/2008 | ||||||||
LastUpdateDate: | 02/06/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-10920 | AZ | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.