Provider Demographics
NPI:1982753554
Name:ARKELL, KATHERINE DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DIANE
Last Name:ARKELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DIANE
Other - Last Name:MAHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5090 STATE ST
Mailing Address - Street 2:SUITE 102-B
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7706
Mailing Address - Country:US
Mailing Address - Phone:469-685-7830
Mailing Address - Fax:248-295-4494
Practice Address - Street 1:5090 STATE ST
Practice Address - Street 2:SUITE 102-B
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7706
Practice Address - Country:US
Practice Address - Phone:469-685-7830
Practice Address - Fax:248-295-4494
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010948021041C0700X
AR1991-C1041C0700X
IDLCSW-257951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06040017501OtherQUALCHOICE PROVIDER ID
AR5Y656Medicare ID - Type Unspecified
AR5Y656OtherBLUE CROSS