Provider Demographics
NPI:1649414228
Name:ARNOLD, GINGER (PHD)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30752 SOUTHVIEW DR STE 130
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7990
Mailing Address - Country:US
Mailing Address - Phone:720-737-8428
Mailing Address - Fax:
Practice Address - Street 1:30752 SOUTHVIEW DR STE 130
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7990
Practice Address - Country:US
Practice Address - Phone:720-737-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042125A103T00000X
CAPSY19200103T00000X
CO3900103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO301107Medicare PIN
IN2617000Medicare PIN