Provider Demographics
NPI:1083648398
Name:TRIPP, DEBRA J (MFT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:TRIPP
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 5TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2656
Mailing Address - Country:US
Mailing Address - Phone:530-458-7342
Mailing Address - Fax:530-458-2373
Practice Address - Street 1:642 5TH ST STE 4
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2656
Practice Address - Country:US
Practice Address - Phone:530-458-7342
Practice Address - Fax:530-458-2373
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist