person
Tyan R Ellsworth, CADC
Addiction (Substance Use Disorder) Counselor in Atlantic, Iowa
NPI 1366684722

Tyan R Ellsworth is an Addiction (Substance Use Disorder) Counselor based in Atlantic, IA and is specialized in Addiction (Substance Use Disorder). Tyan R Ellsworth practices in Atlantic, IA and has the professional credentials of CADC. The NPI Number for Tyan R Ellsworth is 1366684722 and holds a License No. 95005 (Iowa).

The current practice location address for Tyan R Ellsworth is 1500 E 10Th St, Atlantic, IA and can be reached out via phone at 712-243-5091 and via fax at 712-243-1337. You can also correspond with Tyan R Ellsworth through the mailing address at 1500 E 10TH ST, ATLANTIC, IA - 50022-1935 (mailing address contact number: 712-243-5091).

Location: 1500 E 10Th St, Atlantic, IA, 50022-1935
person
Provider Profile Details
NPI Number
1366684722
Provider Name
Tyan R Ellsworth
Credential
CADC
Provider Entity Type
Individual
Gender
Female
Address
1500 E 10Th St, Atlantic, IA, 50022-1935
Phone Number
712-243-5091
Fax Number
712-243-1337
Provider Enumeration Date
04/01/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
68236 01 IA WELLMARK
0177394 05 IA
institution
Provider Business Practice Location Address Details
Address
1500 E 10Th St
City
State
Zip
50022-1935
Phone Number
712-243-5091
Fax Number
712-243-1337
person
Provider Business Mailing Address Details
Address
1500 E 10Th St
City
State
Zip
50022-1935
Phone Number
712-243-5091
Fax Number
712-243-1337
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
95005 (Iowa)
Definition
Definition to come...
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