Healthcare Provider Details

I. General information

NPI: 1528091428
Provider Name (Legal Business Name): JOSHUA BARRETT ARVIDSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 LAKE OTIS PKWY STE 103
ANCHORAGE AK
99508-5227
US

IV. Provider business mailing address

18518 2ND ST
EAGLE RIVER AK
99577-8392
US

V. Phone/Fax

Practice location:
  • Phone: 907-762-2817
  • Fax: 907-561-7093
Mailing address:
  • Phone: 907-762-2817
  • Fax: 907-561-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number606
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: