Healthcare Provider Details

I. General information

NPI: 1841980232
Provider Name (Legal Business Name): MACKENZIE ARNOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax: 614-457-7896
Mailing address:
  • Phone: 614-457-7876
  • Fax: 614-457-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.2102223-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2309106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: