TYAN R ELLSWORTH CADC NPI 1366684722

NPI Information

NPI: 1366684722
Provider Name: TYAN R ELLSWORTH, CADC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1500 E 10TH ST
ATLANTIC, IA
ZIP 50022
Phone: (712) 243-5091
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Tyan R Ellsworth, CADC is an addiction (substance use disorder) counselor in Atlantic, IA. Tyan R Ellsworth, CADC NPI is 1366684722. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1500 E 10TH ST
ATLANTIC, IA
ZIP 50022-935
Phone: (712) 243-5091
Fax: (712) 243-1337

The enumeration date for this NPI number is 4/1/2009 and was last updated on 11/16/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	95005	IOWA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	68236	OTHER	IOWA	WELLMARK
2	0177394	MEDICAID	IOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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