Ellenburg, Tristina Marie
Ellenburg, Tristina Marie is an individual health care provider with primary practice located at 2147 Newnan Crossing Blvd E , Newnan GA 30265-2406. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Ellenburg, Tristina Marie can be contacted via phone (470) 241-1408.Contact Information
Primary practice address
2147 Newnan Crossing Blvd E
Newnan GA 30265-2406
Phone: (470) 241-1408
Fax: (317) 520-8200
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X | 267579 | Kentucky |
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X | COBA.00590 | Ohio |
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X | 1-17-26378 |
Profile Details
| NPI number | 1730607698 |
|---|---|
| LBN Legal business name | Ellenburg, Tristina Marie |
| Credentials | MS, BCBA, COBA, LBA |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 31st, 2017 |
| Last updated | Dec 14th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730607698 | NPPES |
| Other | 1-17-26378 | BCBA CERTIFICATE |
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