Provider Demographics
NPI:1174758700
Name:ARNOLD, JASON O'RYAN (LICSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:O'RYAN
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:O'RYAN
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:2715 WALNUT LOOP NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4439
Mailing Address - Country:US
Mailing Address - Phone:360-852-1202
Mailing Address - Fax:
Practice Address - Street 1:500 COLUMBIA ST NW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4447
Practice Address - Country:US
Practice Address - Phone:253-579-0854
Practice Address - Fax:360-252-6466
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG0585448101YM0800X
WASC611158411041C0700X
WALW614170961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW61417096OtherASWB