Healthcare Provider Details

I. General information

NPI: 1255145983
Provider Name (Legal Business Name): ARNOLD JOHN TILDEN JR. ED.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 SANDY RIDGE RD
STATE COLLEGE PA
16803-1226
US

IV. Provider business mailing address

187 SANDY RIDGE RD
STATE COLLEGE PA
16803-1226
US

V. Phone/Fax

Practice location:
  • Phone: 814-861-5100
  • Fax: 814-861-5100
Mailing address:
  • Phone: 814-861-5100
  • Fax: 814-861-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018120
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: