Provider Demographics
NPI:1255686812
Name:KIPP, AMY A (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:KIPP
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11467 HUEBNER RD STE 251
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1073
Mailing Address - Country:US
Mailing Address - Phone:503-389-5504
Mailing Address - Fax:
Practice Address - Street 1:11467 HUEBNER RD STE 251
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1073
Practice Address - Country:US
Practice Address - Phone:503-389-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0879106H00000X
TX202277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12684503OtherCAQH