Healthcare Provider Details

I. General information

NPI: 1073716395
Provider Name (Legal Business Name): WHITE MOUNTAIN PSYCHOLOGICAL SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 02/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372C W WHITE MOUNTAIN BLVD
LAKESIDE AZ
85929-6906
US

IV. Provider business mailing address

372C W WHITE MOUNTAIN BLVD
LAKESIDE AZ
85929-6906
US

V. Phone/Fax

Practice location:
  • Phone: 928-367-8243
  • Fax: 928-367-8243
Mailing address:
  • Phone: 928-367-8243
  • Fax: 928-367-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3490
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-10183
License Number StateAZ

VIII. Authorized Official

Name: DR. WILLIAM WALTER ARNETT JR.
Title or Position: CEO
Credential: PSY.D.
Phone: 928-367-8243