Healthcare Provider Details

I. General information

NPI: 1801089685
Provider Name (Legal Business Name): JONNIE ARNOLD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 GRAND AVE
PHOENIX AZ
85017
US

IV. Provider business mailing address

1901 E 1ST ST
NEWTON KS
67114-5010
US

V. Phone/Fax

Practice location:
  • Phone: 602-717-2956
  • Fax: 602-441-0613
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-11703
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1123
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: