Provider Demographics
NPI:1457941064
Name:ARNOLD, KAITLIN (LPC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1741
Mailing Address - Country:US
Mailing Address - Phone:313-549-8254
Mailing Address - Fax:
Practice Address - Street 1:705 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1741
Practice Address - Country:US
Practice Address - Phone:313-549-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018903101YM0800X
IL180012722101YM0800X
6401018903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health