Provider Demographics
NPI:1073233375
Name:TINEO, ARTHUR J
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:J
Last Name:TINEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 N 12TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2655
Mailing Address - Country:US
Mailing Address - Phone:281-846-4205
Mailing Address - Fax:
Practice Address - Street 1:9201 N 12TH ST APT D
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2655
Practice Address - Country:US
Practice Address - Phone:281-846-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04372330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor