Provider Demographics
NPI:1346325966
Name:LIPP, CLYDE ANTHONY (LCPC)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:ANTHONY
Last Name:LIPP
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RIVER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1384
Mailing Address - Country:US
Mailing Address - Phone:309-762-5433
Mailing Address - Fax:
Practice Address - Street 1:1701 RIVER DR STE 110
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1384
Practice Address - Country:US
Practice Address - Phone:309-762-5433
Practice Address - Fax:309-762-4481
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health