Provider Demographics
NPI:1215553862
Name:BRUTLAG, ARIN M (MA)
Entity Type:Individual
Prefix:
First Name:ARIN
Middle Name:M
Last Name:BRUTLAG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ARIN
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3740 W SYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5446
Mailing Address - Country:US
Mailing Address - Phone:471-413-3507
Mailing Address - Fax:
Practice Address - Street 1:3740 W SYLVANIA ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5446
Practice Address - Country:US
Practice Address - Phone:417-413-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020027674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist