Provider Demographics
NPI:1962840389
Name:DRIPPS, TYRONE (CACD-1)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:DRIPPS
Suffix:
Gender:M
Credentials:CACD-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 COMMERCIAL ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5207
Mailing Address - Country:US
Mailing Address - Phone:503-370-8050
Mailing Address - Fax:503-370-9982
Practice Address - Street 1:2001 COMMERCIAL ST SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5207
Practice Address - Country:US
Practice Address - Phone:503-370-8050
Practice Address - Fax:503-370-9982
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-06-17101YA0400X
ORC4722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)