Provider Demographics
NPI:1043977788
Name:ARTISON, TOBHIYAS
Entity Type:Individual
Prefix:
First Name:TOBHIYAS
Middle Name:
Last Name:ARTISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W PFLUGERVILLE PKWY APT 410
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2455
Mailing Address - Country:US
Mailing Address - Phone:276-920-9281
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAYS ST STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6709
Practice Address - Country:US
Practice Address - Phone:512-305-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT21192685106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician