Provider Demographics
NPI:1407425408
Name:ARNOLD, BRY'ESHA CHANTE
Entity Type:Individual
Prefix:
First Name:BRY'ESHA
Middle Name:CHANTE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 PACKARD ST STE 208
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6827
Mailing Address - Country:US
Mailing Address - Phone:734-929-2620
Mailing Address - Fax:
Practice Address - Street 1:2500 PACKARD ST STE 208
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6827
Practice Address - Country:US
Practice Address - Phone:734-929-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA654098115947OtherDRIVER'S LICENSE