Tracy D. Ellman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4724 Issued in OK

Practice address

30 C St NE
Miami, OK 74354-6316

Phone

(918) 540-1563

Fax

(918) 542-7778

NPI assigned

Jan 23, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1264204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1124359682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 C ST NE",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743546316",
            "telephone_number": "918-540-1563",
            "fax_number": "918-542-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 C ST NE",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743546316",
            "telephone_number": "918-540-1563",
            "fax_number": "918-542-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLMAN",
        "first_name": "TRACY",
        "middle_name": "D.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-23",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "4724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100732380C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kory Lee Eden, BS
• Gary L Elam, DPH
• Robert Todd Elias
• Mark Wayne Elkington, M.D.
• Joseph Ellis
• Amanda Jo Epperson, R.N.
• Ashley Nicole Evans, P.T.A.
• Eye Associates of Miami, Inc.
• Kyrie Rae Fairweather, APRN, NP-C
• Family Care Solutions, Inc

• Clinical Social Worker in Miami, OK
• Providers in Miami, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.