Basic Information
| Provider Information | |||||||||
| NPI: | 1114527116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARLT | ||||||||
| FirstName: | ETHAN | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W MAIN ST STE 4B | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975012734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414141720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1836 FREMONT ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975202537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414825792 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2020 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.