Provider Demographics
NPI:1447269055
Name:ARNOLD, BILL R (PH D, ABPP)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:R
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:PH D, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 E FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5953
Mailing Address - Country:US
Mailing Address - Phone:208-855-0660
Mailing Address - Fax:208-898-9433
Practice Address - Street 1:2770 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5953
Practice Address - Country:US
Practice Address - Phone:208-855-0660
Practice Address - Fax:208-898-9433
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID352343031OtherTIN
ID352343031OtherTIN