Tracy L Baxley Tullos, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2041C Issued in AR

Practice address

3106 W 2ND CT
Suite 1
Russellville, AR 72801-4503

Phone

(479) 880-5100

Fax

(479) 880-5297

NPI assigned

Sep 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tracy Tullos Southern Therapy Specialists

  • Clinical Social Worker
  • Russellville, AR
  • NPI 1114394285

  Clinical

  NPD (past) Authorized official

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1124120712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3106 W 2ND CT",
            "address_2": "SUITE 1",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728014503",
            "telephone_number": "479-880-5100",
            "fax_number": "479-880-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3106 W 2ND CT",
            "address_2": "SUITE 1",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728014503",
            "telephone_number": "479-880-5100",
            "fax_number": "479-880-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLOS",
        "first_name": "TRACY",
        "middle_name": "L BAXLEY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "2041C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Trouerbach, QBHP
• Leah Katherine Trusty, OTD
• Carolyne Tucker, LCSW
• Trakia Tucker
• Samantha Tuell
• David Alan Turner, PHARMD
• Kenneth B Turner, MD
• Layne Turner
• Shaneleigh Skylar Turner
• Twin Rivers Respiratory Care, Inc

• Clinical Social Worker in Russellville, AR
• Providers in Russellville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.