Ellman, Tracy D.
Ellman, Tracy D. is an individual health care provider with primary practice located at 30 C St Ne , Miami OK 74354-6316. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Ellman, Tracy D. can be contacted via phone (918) 540-1563.Contact Information
Primary practice address
30 C St Ne
Miami OK 74354-6316
Phone: (918) 540-1563
Fax: (918) 542-7778
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 4724 | Oklahoma |
Profile Details
| NPI number | 1124359682 |
|---|---|
| LBN Legal business name | Ellman, Tracy D. |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 23rd, 2010 |
| Last updated | Jan 29th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124359682 | NPPES |
| Oklahoma | MEDICAID | 100732380C |
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