Provider Demographics
NPI:1598156424
Name:ARTIS, TAJ Y (LCSW)
Entity Type:Individual
Prefix:
First Name:TAJ
Middle Name:Y
Last Name:ARTIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 CHRISTINE CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1701
Mailing Address - Country:US
Mailing Address - Phone:217-791-1755
Mailing Address - Fax:
Practice Address - Street 1:1301 N CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-1830
Practice Address - Country:US
Practice Address - Phone:217-531-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW19032101YM0800X
104100000X
IL1490184731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker