Provider Demographics
NPI:1790910453
Name:BENJAMIN D ARNOLD PSYCHOLOGIST LLC
Entity Type:Organization
Organization Name:BENJAMIN D ARNOLD PSYCHOLOGIST LLC
Other - Org Name:BENJAMIN D ARNOLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:318-442-7812
Mailing Address - Street 1:300 EDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5445
Mailing Address - Country:US
Mailing Address - Phone:318-442-7812
Mailing Address - Fax:
Practice Address - Street 1:300 EDGEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5445
Practice Address - Country:US
Practice Address - Phone:318-442-7812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA679103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG4486OtherBLUE CROSS