Provider Demographics
NPI:1619032562
Name:ARROWHEAD PSYCHOLOGICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:ARROWHEAD PSYCHOLOGICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:PLUDE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:218-723-8153
Mailing Address - Street 1:324 W SUPERIOR ST
Mailing Address - Street 2:STE 600
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1701
Mailing Address - Country:US
Mailing Address - Phone:218-723-8153
Mailing Address - Fax:218-722-7625
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:STE 600
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-723-8153
Practice Address - Fax:218-722-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800122-1-MHC103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO8169Medicare PIN