Provider Demographics
NPI:1972041903
Name:SPENCER, ARTHUR
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7596 N MONA LISA RD
Mailing Address - Street 2:APT11203
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7596 N MONA LISA RD
Practice Address - Street 2:APT11203
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4596
Practice Address - Country:US
Practice Address - Phone:661-433-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-16-27333106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician