Provider Demographics
NPI:1144622408
Name:ARNOLD, JUSTIN LEE
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:ARNOLD
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 1:7139 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3656
Mailing Address - Country:US
Mailing Address - Phone:210-954-3303
Mailing Address - Fax:
Practice Address - Street 1:7390 W SAHARA AVE STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2764
Practice Address - Country:US
Practice Address - Phone:702-305-0234
Practice Address - Fax:702-549-8222
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7857-S104100000X
NVIC-12301041C0700X
NV10160-C1041C0700X
225C00000X
NV10161-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor