Provider Demographics
NPI:1669151411
Name:ARTISON, ALICIA DANILLE (MSW)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:DANILLE
Last Name:ARTISON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:D
Other - Last Name:ARTISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:1169 W CRANE DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7412
Mailing Address - Country:US
Mailing Address - Phone:336-987-3282
Mailing Address - Fax:
Practice Address - Street 1:606 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-5140
Practice Address - Country:US
Practice Address - Phone:541-426-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health