Provider Demographics
NPI:1902437486
Name:CRAYTON, TAI HESIA (LCSW)
Entity Type:Individual
Prefix:
First Name:TAI HESIA
Middle Name:
Last Name:CRAYTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAI
Other - Middle Name:
Other - Last Name:CRAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2743 W 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7294
Mailing Address - Country:US
Mailing Address - Phone:219-757-1257
Mailing Address - Fax:
Practice Address - Street 1:5401 BROADWAY STE F
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1684
Practice Address - Country:US
Practice Address - Phone:219-757-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0218771041C0700X
IN34008486A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical