Provider Demographics
NPI:1477106243
Name:ARNOLD, ELLIE S (PLMHP)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:S
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:S
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMHP
Mailing Address - Street 1:11949 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3503
Mailing Address - Country:US
Mailing Address - Phone:402-595-1326
Mailing Address - Fax:
Practice Address - Street 1:11949 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3503
Practice Address - Country:US
Practice Address - Phone:402-595-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19-95895106S00000X
106S00000X
NE12766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician