Provider Demographics
NPI:1427203363
Name:ARNOLD, TISHA (LMFT)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11471 BUSINESS BLVD UNIT 771572
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0659
Mailing Address - Country:US
Mailing Address - Phone:907-229-5689
Mailing Address - Fax:910-400-4748
Practice Address - Street 1:11471 BUSINESS BLVD UNIT 771572
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-0659
Practice Address - Country:US
Practice Address - Phone:907-229-5689
Practice Address - Fax:910-400-4748
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009037392106H00000X
KS2804106H00000X
CAMFC 40838106H00000X
AK178321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009037392OtherDIVISION OF PROFESSIONAL REGISTRATON
AK178321OtherAK BOARD OF MARITAL & FAMILY THERAPY
KS2804OtherKANSAS BSRB