Healthcare Provider Details

I. General information

NPI: 1083144810
Provider Name (Legal Business Name): ARTHUR FLYINGEAGLECLAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ARTHUR DANIEL ARREDONDO

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 D ST STE G
MARYSVILLE CA
95901-5957
US

IV. Provider business mailing address

201 D ST STE G
MARYSVILLE CA
95901-5957
US

V. Phone/Fax

Practice location:
  • Phone: 530-237-1715
  • Fax: 530-742-7642
Mailing address:
  • Phone: 530-237-1715
  • Fax: 530-742-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: