Provider Demographics
NPI:1164142998
Name:LIPSEY, TYMEISHA
Entity Type:Individual
Prefix:
First Name:TYMEISHA
Middle Name:
Last Name:LIPSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 RUBY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1014
Mailing Address - Country:US
Mailing Address - Phone:614-599-3763
Mailing Address - Fax:
Practice Address - Street 1:871 RUBY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1014
Practice Address - Country:US
Practice Address - Phone:614-599-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator