Tracy D. Ellman, LCSW
Social Worker, Clinical in Miami, OK. Individual provider (NPI-1).
NPI number1124359682
StatusActive
Last updated in NPPESJan 29, 2015
Details
- NPI
- 1124359682
- Entity type
- Individual (NPI-1)
- Name
- Mr. Tracy D. Ellman
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 23, 2010
- Last updated
- Jan 29, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 4724 | OK | Yes |
| 1041C0700X | Social Worker, Clinical | – | – |
Practice location
30 C St NeMiami, OK 74354-6316
Phone 918-540-1563 · Fax 918-542-7778
Mailing address
30 C St NeMiami, OK 74354-6316
Phone 918-540-1563 · Fax 918-542-7778
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