Provider Demographics
NPI:1134508872
Name:LIPP, KATELYN A (MA, LPC, LMFT, CAADC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:A
Last Name:LIPP
Suffix:
Gender:F
Credentials:MA, LPC, LMFT, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39111 6 MILE RD STE 152
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3926
Mailing Address - Country:US
Mailing Address - Phone:248-470-1102
Mailing Address - Fax:
Practice Address - Street 1:41700 GARDENBROOK RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-470-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006658106H00000X
MI6401014878101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist