Provider Demographics
NPI:1942608633
Name:CHANNER, ARTHUR (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:CHANNER
Suffix:
Gender:M
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 S ANITA BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1114
Mailing Address - Country:US
Mailing Address - Phone:321-624-8657
Mailing Address - Fax:813-839-4514
Practice Address - Street 1:4304 S ANITA BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1114
Practice Address - Country:US
Practice Address - Phone:321-624-8657
Practice Address - Fax:813-839-4514
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1021041103K00000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator