Provider Demographics
NPI:1457499451
Name:ARNOLD, BETTY JEAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JEAN
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 EDISON SHORES LN
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3378
Mailing Address - Country:US
Mailing Address - Phone:810-982-3562
Mailing Address - Fax:
Practice Address - Street 1:1600 GRATIOT BLVD
Practice Address - Street 2:BLDG B, SUITE 4
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1145
Practice Address - Country:US
Practice Address - Phone:810-364-5800
Practice Address - Fax:810-364-1200
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006236101YM0800X
MI6301009962103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling