Provider Demographics
NPI:1033236161
Name:LIPPERT, JAMES G (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:LIPPERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 BRIGHTON WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3871
Mailing Address - Country:US
Mailing Address - Phone:775-324-5277
Mailing Address - Fax:
Practice Address - Street 1:3545 BRIGHTON WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3871
Practice Address - Country:US
Practice Address - Phone:775-324-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV106103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist