Provider Demographics
NPI:1831166115
Name:ARTHUR, MAIKA MARIE (PSYD HSPP)
Entity type:Individual
Prefix:DR
First Name:MAIKA
Middle Name:MARIE
Last Name:ARTHUR
Suffix:
Gender:F
Credentials:PSYD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S ROGERS ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4760
Mailing Address - Country:US
Mailing Address - Phone:812-339-3632
Mailing Address - Fax:812-339-3632
Practice Address - Street 1:901 S ROGERS ST STE 106
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4760
Practice Address - Country:US
Practice Address - Phone:812-339-3632
Practice Address - Fax:812-339-3632
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041758A103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000334004OtherANTHEM
IN251420Medicare PIN