Provider Demographics
NPI:1588782031
Name:LIPP, PATRICK KEITH (MS)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:KEITH
Last Name:LIPP
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11908 E OLD PALOUSE HWY
Mailing Address - Street 2:
Mailing Address - City:VALLEYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036-9503
Mailing Address - Country:US
Mailing Address - Phone:150-992-2465
Mailing Address - Fax:
Practice Address - Street 1:1005 N PINES RD
Practice Address - Street 2:SUITE 250
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4986
Practice Address - Country:US
Practice Address - Phone:150-992-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health