Provider Demographics
NPI:1437772613
Name:ARNOLD, JUSTIN PRENTIS (MAMFC, LPC-S)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PRENTIS
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MAMFC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 TIMBER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-8288
Mailing Address - Country:US
Mailing Address - Phone:469-279-5551
Mailing Address - Fax:
Practice Address - Street 1:2137 GEORGE RICHEY RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-9732
Practice Address - Country:US
Practice Address - Phone:903-759-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68187101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX68187OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS