Provider Demographics
NPI:1831340520
Name:ARTHUR, IAN THOMAS (PHD, HSPP)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:THOMAS
Last Name:ARTHUR
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N EAGLESON AVE
Mailing Address - Street 2:RM 435
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47405-3190
Mailing Address - Country:US
Mailing Address - Phone:812-855-5711
Mailing Address - Fax:
Practice Address - Street 1:600 N EAGLESON AVE
Practice Address - Street 2:RM 435
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3190
Practice Address - Country:US
Practice Address - Phone:812-855-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043678B103TP2701X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy