Provider Demographics
NPI:1649393117
Name:ARNOLD, GLEN (PHD)
Entity Type:Individual
Prefix:
First Name:GLEN
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 1:1700 ASHE RD UNIT 38
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3605
Mailing Address - Country:US
Mailing Address - Phone:661-832-3808
Mailing Address - Fax:
Practice Address - Street 1:44900 60TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7618
Practice Address - Country:US
Practice Address - Phone:661-948-8581
Practice Address - Fax:661-945-8474
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14301Medicare ID - Type Unspecified