NPIMap

Organization Active NPI

Tracy Tullos Southern Therapy Specialists

  • Clinical Social Worker
  • Russellville, AR
National Provider Identifier
1114394285
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
TRACY TULLOS SOUTHERN THERAPY SPECIALISTS
Practice address
701 E Main St
Suite 2
Russellville, AR 72801-5247
Phone
(479) 576-2799
NPI assigned
Aug 25, 2015
Last updated
Oct 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy Tullos, LCSWNPI 1124120712
Title
Owner
Phone
(479) 576-2799

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

701 E Main St
Suite 2
Russellville, AR 72801-5247

Mailing address

PO Box 9178
Russellville, AR 72811-9178
Phone (479) 498-6750

National Provider Directory

National Provider Directory

Locations

701 E Main St
Ste 2
Russellville, AR 72801
Phone (479) 268-7773

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1114394285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9178",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728119178",
            "telephone_number": "479-498-6750",
            "fax_number": "479-968-1673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E MAIN ST",
            "address_2": "SUITE 2",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728015247",
            "telephone_number": "479-576-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY TULLOS SOUTHERN THERAPY SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "TULLOS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-576-2799",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.