Provider Demographics
NPI:1558960369
Name:ARNOLD, JATAEVA JANAY
Entity Type:Individual
Prefix:
First Name:JATAEVA
Middle Name:JANAY
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 S EAST END AVE APT 3508S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-0067
Mailing Address - Country:US
Mailing Address - Phone:407-758-2783
Mailing Address - Fax:
Practice Address - Street 1:4801 SOUTHWICK DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2254
Practice Address - Country:US
Practice Address - Phone:407-758-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health