Provider Demographics
NPI:1114125374
Name:ARNOLD, JOSEPH SMITH (LCC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SMITH
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:LCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 DOGWOOD CROSS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-7914
Mailing Address - Country:US
Mailing Address - Phone:502-310-9091
Mailing Address - Fax:502-384-2855
Practice Address - Street 1:9710 PARK PLAZA AVE UNIT 204
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2293
Practice Address - Country:US
Practice Address - Phone:502-384-2844
Practice Address - Fax:502-384-2855
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0845101YA0400X
KYKY-0027101YM0800X
KY104211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health