Provider Demographics
NPI:1184006231
Name:TIPPITT, JEAN NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:NICOLE
Last Name:TIPPITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 VOLUNTEER DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5482
Mailing Address - Country:US
Mailing Address - Phone:731-642-3600
Mailing Address - Fax:731-642-6037
Practice Address - Street 1:849 VOLUNTEER DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5482
Practice Address - Country:US
Practice Address - Phone:731-642-3600
Practice Address - Fax:731-642-6037
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39224262OtherGROUP MEDICVARE
TN1508500OtherGROUP MEDICAID
TNQ015397Medicaid
TNQ015397Medicaid