MEDICARE: DEBBIE LEIGH ELLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1821773425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE LEIGH ELLIS

Provider Business Mailing Address
First Line	:	2218 E 59TH ST APT 2601
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7047
Country	:	US
Telephone Number	:	918-361-8772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 E 59TH ST # 2601
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7004
Country	:	US
Telephone Number	:	918-430-0975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “ DEBBIE LEIGH ELLIS ” Practice Location

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