Individual
TRACY KENT ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 N BROADWAY ST, POTEAU, OK 74953-2617
(918) 809-0112
Mailing address
208 N WITTE ST, POTEAU, OK 74953-3926
(918) 809-0112
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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