Provider Demographics
NPI:1174012835
Name:BACK, ARLETTE J (LPC)
Entity Type:Individual
Prefix:
First Name:ARLETTE
Middle Name:J
Last Name:BACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S COULTER ST BLDG A STE 100
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1744
Mailing Address - Country:US
Mailing Address - Phone:806-680-6651
Mailing Address - Fax:
Practice Address - Street 1:1600 S COULTER ST BLDG A STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1744
Practice Address - Country:US
Practice Address - Phone:806-680-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387183201Medicaid