Healthcare Provider Details

I. General information

NPI: 1649070210
Provider Name (Legal Business Name): TAMAYA STATEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 GOVERNORS DR STE 352
OLYMPIA FIELDS IL
60461-1032
US

IV. Provider business mailing address

20200 GOVERNORS DR STE 352
OLYMPIA FIELDS IL
60461-1032
US

V. Phone/Fax

Practice location:
  • Phone: 773-330-3713
  • Fax:
Mailing address:
  • Phone: 773-330-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149028932
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: