Provider Demographics
NPI:1063558062
Name:TIPPMAN, DOUGLAS (LMFT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:TIPPMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 H ST STE 5N
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-3737
Mailing Address - Country:US
Mailing Address - Phone:707-465-4657
Mailing Address - Fax:
Practice Address - Street 1:550 H ST STE 5N
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3737
Practice Address - Country:US
Practice Address - Phone:707-465-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist