Provider Demographics
NPI:1679993018
Name:ARNOLD, NORMAN DAVID (LAC)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:DAVID
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 158TH RD.
Mailing Address - Street 2:P.O. BOX 174
Mailing Address - City:MAYETTA
Mailing Address - State:KS
Mailing Address - Zip Code:66509-0174
Mailing Address - Country:US
Mailing Address - Phone:785-966-8352
Mailing Address - Fax:785-966-8352
Practice Address - Street 1:11400 158TH RD.
Practice Address - Street 2:
Practice Address - City:MAYETTA
Practice Address - State:KS
Practice Address - Zip Code:66509-0174
Practice Address - Country:US
Practice Address - Phone:785-966-8200
Practice Address - Fax:785-966-8386
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS568101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)