Provider Demographics
NPI:1770579351
Name:STORY, ARLENE K (MS LMHC TEP CHDAC)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:K
Last Name:STORY
Suffix:
Gender:F
Credentials:MS LMHC TEP CHDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14835 SE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:OCKLAWAHA
Mailing Address - State:FL
Mailing Address - Zip Code:32179-3556
Mailing Address - Country:US
Mailing Address - Phone:866-473-3864
Mailing Address - Fax:352-288-3343
Practice Address - Street 1:14835 SE 85TH ST
Practice Address - Street 2:
Practice Address - City:OCKLAWAHA
Practice Address - State:FL
Practice Address - Zip Code:32179-3556
Practice Address - Country:US
Practice Address - Phone:866-473-3843
Practice Address - Fax:352-288-3343
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001215A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000349354OtherANTHEM
0007139568OtherAETNA US HEALTHCARE
58659000OtherMAGELLAN BEHAVIORAL HEALT