Provider Demographics
NPI:1700218898
Name:MAXWELL, ARTURO S (PHD IN PROGRESS)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:S
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:PHD IN PROGRESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 RIVERVIEW DR
Mailing Address - Street 2:BUILDING A SUITE 180
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-5065
Mailing Address - Country:US
Mailing Address - Phone:269-815-5218
Mailing Address - Fax:
Practice Address - Street 1:777 RIVERVIEW DR
Practice Address - Street 2:BUILDING A SUITE 180
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-5065
Practice Address - Country:US
Practice Address - Phone:269-815-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1578900049Medicaid