Provider Demographics
NPI:1770073165
Name:ARN, AMANDA BETH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:ARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 LAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1026
Mailing Address - Country:US
Mailing Address - Phone:330-524-9239
Mailing Address - Fax:
Practice Address - Street 1:181 LAKE TERRACE DR
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1026
Practice Address - Country:US
Practice Address - Phone:330-524-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.166721101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)