Provider Demographics
NPI:1073818050
Name:TIPS, TAMALYN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TAMALYN
Middle Name:
Last Name:TIPS
Suffix:
Gender:F
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 1:809 WEB ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5832
Mailing Address - Country:US
Mailing Address - Phone:817-300-8809
Mailing Address - Fax:
Practice Address - Street 1:1307B W ABRAM ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-1700
Practice Address - Country:US
Practice Address - Phone:817-300-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health