=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790910453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENJAMIN D ARNOLD PSYCHOLOGIST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2009
-----------------------------------------------------
Last Update Date | 05/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 EDGEWOOD DRIVE
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-5445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-442-7812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 EDGEWOOD DRIVE
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-5445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-442-7812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DR. BENJAMIN D ARNOLD
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 318-442-7812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 679
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------