Provider Demographics
NPI:1972220507
Name:ARNOLD, JUSTIN L
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:L
Last Name:ARNOLD
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 1:4209 W ROSAMOND BLVD SPC 85
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-6592
Mailing Address - Country:US
Mailing Address - Phone:661-233-6876
Mailing Address - Fax:
Practice Address - Street 1:4209 W ROSAMOND BLVD SPC 85
Practice Address - Street 2:
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560-6592
Practice Address - Country:US
Practice Address - Phone:661-233-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)