Individual
ELLEN MARIE TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
110 FIFTH ST, STE. 103, KETCHUM, ID 83353
(208) 720-7868
Mailing address
PO BOX 6282, SUN VALLEY, ID 83354
(208) 720-7868
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT-3837
ID
106H00000X
Marriage & Family Therapist
MFC-30249
CA
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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