Provider Demographics
NPI:1558329987
Name:ARNOLD, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N ARGONNE RD
Mailing Address - Street 2:C160
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2545
Mailing Address - Country:US
Mailing Address - Phone:509-389-2151
Mailing Address - Fax:509-742-3461
Practice Address - Street 1:1521 N ARGONNE RD
Practice Address - Street 2:C160
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2545
Practice Address - Country:US
Practice Address - Phone:509-389-2151
Practice Address - Fax:509-742-3461
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001936103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8427544Medicaid
WAAB11723Medicare PIN
WA8427544Medicaid