Provider Demographics
NPI:1336474121
Name:LIPS, TINA G (LPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:G
Last Name:LIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE MULTNOMAH ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2131
Mailing Address - Country:US
Mailing Address - Phone:503-729-1380
Mailing Address - Fax:503-841-6343
Practice Address - Street 1:700 NE MULTNOMAH ST
Practice Address - Street 2:SUITE 275
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2131
Practice Address - Country:US
Practice Address - Phone:503-729-1380
Practice Address - Fax:503-841-6343
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60329329101YM0800X
ORC2484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health