Basic Information
| Provider Information | |||||||||
| NPI: | 1306050158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | LUKE | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A, LMFT, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 SANTA MARIA DR | ||||||||
| Address2: | |||||||||
| City: | EDGEWOOD | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870159700 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1218 GRIEGOS RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871073752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053458471 | ||||||||
| FaxNumber: | 5053425414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 0090501 | NM | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 41945 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 44805268 | 05 | NM | MEDICAID |