Provider Demographics
NPI:1154359800
Name:TRIPP, ROGER FRANKLIN (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:FRANKLIN
Last Name:TRIPP
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 WINDGAP DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3249
Mailing Address - Country:US
Mailing Address - Phone:210-690-4689
Mailing Address - Fax:210-704-3053
Practice Address - Street 1:333 N SANTA ROSA AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-2266
Practice Address - Fax:210-704-3053
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health