Healthcare Provider Details

I. General information

NPI: 1124036660
Provider Name (Legal Business Name): CYNTHIA LYNNE ARNOLD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW MARKET ST STE 390
PORTLAND OR
97201-5731
US

IV. Provider business mailing address

20796 SW GRACIE ST
BEAVERTON OR
97006-1574
US

V. Phone/Fax

Practice location:
  • Phone: 503-274-0996
  • Fax:
Mailing address:
  • Phone: 503-274-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1620
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: