Individual
MR. TRACY D. ELLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
30 C ST NE, MIAMI, OK 74354-6316
(918) 540-1563
(918) 542-7778
Mailing address
30 C ST NE, MIAMI, OK 74354-6316
(918) 540-1563
(918) 542-7778
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4724
OK
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100732380C
—
OK
Enumeration date
01/23/2010
Last updated
01/29/2015
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