Provider Demographics
NPI:1104340967
Name:ARNOLD, MISCHA BOURG (MS, CRC, CVE)
Entity type:Individual
Prefix:
First Name:MISCHA
Middle Name:BOURG
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MS, CRC, CVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5126
Mailing Address - Country:US
Mailing Address - Phone:985-674-0488
Mailing Address - Fax:
Practice Address - Street 1:823 CARROLL ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5126
Practice Address - Country:US
Practice Address - Phone:985-788-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor