Individual
TRACY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
70 N MAIN ST STE 104, BOUNTIFUL, UT 84010-6115
(801) 298-5222
(801) 294-0295
Mailing address
70 N MAIN ST STE 104, BOUNTIFUL, UT 84010-6115
(801) 298-5222
(801) 294-0295
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
10949998-2501
UT
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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