Healthcare Provider Details

I. General information

NPI: 1689361537
Provider Name (Legal Business Name): AMANDA CAROL ARNOLD LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MENOMONEE RIVER PKWY
MILWAUKEE WI
53222-4545
US

IV. Provider business mailing address

9700 W EUCLID AVE
MILWAUKEE WI
53227-4223
US

V. Phone/Fax

Practice location:
  • Phone: 925-209-4138
  • Fax:
Mailing address:
  • Phone: 925-209-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10659-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: